Gerna Giuseppe, Lilleri Daniele, Furione Milena, Castiglioni Barbara, Meloni Federica, Rampino Teresa, Agozzino Manuela, Arbustini Eloisa
Laboratori Sperimentali di Ricerca, Area Trapiantologica, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.
New Microbiol. 2012 Jul;35(3):279-87. Epub 2012 Jun 30.
Human cytomegalovirus (HCMV) end-organ disease in solid-organ transplant recipients (SOTR) may be associated with either high or low HCMV load in blood. In transplantation Centers where the preemptive therapy approach is adopted, antiviral therapy of systemic HCMV infections is initiated upon reaching pre-determined cut-off levels of viral DNA in blood, whereas no guidelines are provided for local end-organ infection/disease. In the latter case, clinicians often start antiviral treatment without defining the etiology of local symptoms. Here, we describe 14 cases of SOTR, in which a documented HCMV end-organ disease was observed. Nine patients had a systemic viral load lower than the cut-off for preemptive therapy and were treated based on viral load of local HCMV disease. The remaining five patients had a systemic viral load greater than the preemptive therapy cut-off and were efficiently treated for both the systemic and the local HCMV disease. Thus, HCMV infection in the post-transplant period must be monitored virologically both in blood and locally. End-organ disease in preemptively treated patients, seems to be associated with lack of development (primary HCMV infection) or reconstitution (reactivated infection) of HCMV-specific CD4+ and CD8+ T-cell immunity or with its functional impairment.
实体器官移植受者（SOTR）中的人巨细胞病毒（HCMV）终末器官疾病可能与血液中HCMV载量高或低有关。在采用抢先治疗方法的移植中心，当血液中病毒DNA达到预定临界值时，即开始对全身性HCMV感染进行抗病毒治疗，而对于局部终末器官感染/疾病则未提供指导原则。在后一种情况下，临床医生通常在未明确局部症状病因的情况下就开始抗病毒治疗。在此，我们描述了14例SOTR病例，其中观察到有记录的HCMV终末器官疾病。9例患者的全身病毒载量低于抢先治疗的临界值，并根据局部HCMV疾病的病毒载量进行治疗。其余5例患者的全身病毒载量高于抢先治疗的临界值，并对全身性和局部HCMV疾病均进行了有效治疗。因此，移植后时期的HCMV感染必须在血液和局部进行病毒学监测。抢先治疗患者的终末器官疾病似乎与HCMV特异性CD4+和CD8+ T细胞免疫缺乏发育（原发性HCMV感染）或重建（再激活感染）或其功能受损有关。
