Renal Division, Ghent University Hospital, Ghent, Belgium.
Am J Kidney Dis. 2011 Jul;58(1):118-26. doi: 10.1053/j.ajkd.2011.04.010.
Infection with human cytomegalovirus (CMV) is an important cause of morbidity and mortality in kidney transplant recipients. CMV disease is diagnosed based on the detection of viral replication by phosphoprotein 65 antigenemia or CMV DNA polymerase chain reaction in combination with typical signs and symptoms. Risk factors include CMV-seronegative recipients receiving a CMV-seropositive transplant, older donor age, exposure to cyclosporine and/or antilymphocyte antibody, rejection episodes, and impaired transplant function. Current preventive strategies in kidney transplant recipients include pre-emptive therapy with valganciclovir or intravenous ganciclovir and universal prophylaxis with valacyclovir, valganciclovir, or ganciclovir for 3-6 months after kidney transplantation and for 1-3 months after treatment with antilymphocyte antibody. Established disease should be treated using either intravenous ganciclovir or oral valganciclovir until CMV replication can no longer be detected. In addition to direct effects, CMV infection also induces a wide range of indirect effects, such as decreased transplant and recipient survival and susceptibility to rejection and opportunistic infections. In this review, we highlight the most relevant topics on CMV and kidney transplantation based on current evidence and guidelines.
人巨细胞病毒（CMV）感染是肾移植受者发病率和死亡率的重要原因。CMV 病的诊断基于通过磷蛋白 65 抗原血症或 CMV DNA 聚合酶链反应检测病毒复制，并结合典型的体征和症状。危险因素包括 CMV 阴性受者接受 CMV 阳性移植、供体年龄较大、接触环孢素和/或抗淋巴细胞抗体、排斥反应发作以及移植功能受损。目前肾移植受者的预防策略包括使用缬更昔洛韦或更昔洛韦进行抢先治疗，以及在肾移植后 3-6 个月和使用抗淋巴细胞抗体治疗后 1-3 个月，使用伐昔洛韦、缬更昔洛韦或更昔洛韦进行普遍预防。对于已确诊的疾病，应使用更昔洛韦静脉注射或缬更昔洛韦口服治疗，直至无法检测到 CMV 复制。除了直接作用外，CMV 感染还会引起广泛的间接作用，例如降低移植和受者的存活率以及对排斥和机会性感染的易感性。在这篇综述中，我们根据当前的证据和指南，重点介绍了与 CMV 和肾移植相关的最相关主题。
