Imamura Teruhiko, Shiga Taro, Kinugawa Koichiro, Kato Naoko, Endo Miyoko, Inaba Toshiro, Maki Hisataka, Hatano Masaru, Yao Atsushi, Hirata Yasunobu, Nagai Ryozo
Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo, Japan.
Int Heart J. 2012;53(3):199-201. doi: 10.1536/ihj.53.199.
Cytomegalovirus (CMV) infection remains a major problem in recipients with heart transplantation (HTx), because it may play a significant role in the development of cardiac allograft vasculopathy, which is one of the major causes of death after HTx. Valganciclovir (VGC) is effective for the treatment of CMV infection, but is often associated with neutropenia, especially when used with mycophenolate mophetil (MMF). We experienced an HTx recipient with positive CMV antigenemia who suffered progressive neutropenia after administration of VGC. We switched MMF to everolimus (EVL) and assay for CMV antigenemia was constantly negative even after discontinuation of VGC. In all other 14 HTx recipients who received EVL for any reason, we found that assay for CMV antigenemia remained negative throughout the period of EVL administration. Considering the prophylactic effect on CMV, EVL can not only be an alternative to rescue from comorbidity, but might also be indicated earlier especially in CMV-seronegative HTx recipients.
巨细胞病毒（CMV）感染仍是心脏移植（HTx）受者面临的一个主要问题，因为它可能在心脏移植血管病变的发生发展中起重要作用，而心脏移植血管病变是HTx术后的主要死亡原因之一。缬更昔洛韦（VGC）对CMV感染有效，但常与中性粒细胞减少相关，尤其是与霉酚酸酯（MMF）合用时。我们遇到一名CMV抗原血症阳性的HTx受者，在使用VGC后出现进行性中性粒细胞减少。我们将MMF换成了依维莫司（EVL），即使在停用VGC后，CMV抗原血症检测仍持续呈阴性。在其他14名因任何原因接受EVL治疗的HTx受者中，我们发现，在整个EVL给药期间，CMV抗原血症检测均保持阴性。考虑到对CMV的预防作用，EVL不仅可以作为一种替代方法来缓解合并症，而且可能尤其适用于CMV血清学阴性的HTx受者，可更早使用。
