Departments of Virology, Transplantation and Liver Surgery Clinic, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.
J Clin Virol. 2013 May;57(1):50-3. doi: 10.1016/j.jcv.2013.01.013. Epub 2013 Feb 9.
Cytomegalovirus (CMV) is a significant infectious agent after liver transplantation. To prevent CMV, most centres use prophylaxis for high-risk CMV-seronegative recipient/seropositive donor and many even for all seropositive recipients. However, pre-emptive therapy is commonly used for seropositive patients.
A prospective, long-term follow-up of CMV-seropositive adult liver-transplant patients under pre-emptive strategy was investigated.
CMV-seropositive liver recipients were monitored for CMV by real-time quantitative plasma polymerase chain reaction (PCR) and received ganciclovir/valganciclovir pre-emptive therapy. The 161 patients with follow-up of >4 years were included in the study.
No CMV was detected in most cases 98/161 (61%), but 63/161 (39%) developed CMV-DNAaemia mean 49 days (7-183 days) after transplantation. Only 25/63 reactivations exceeded 5000 copies/ml, which was considered as cut-off for the pre-emptive treatment by the method used (median 21,500, range 5100-813300 copies/ml) and most were self-limiting, low-level DNAaemias (median 850, range 234-4000 copies/ml). Thus, low-level temporal CMV viraemia occurred in 38/161 patients (23.5%) and only 25/161 (15.5%) demonstrated significant viral loads. Recurrent CMV appeared in one patient with low-level and in 11/25 with high-level DNAaemia, only 5/11 exceeding 5000 copies/ml. CMV infections were successfully treated with ganciclovir/valganciclovir. Four patients with low and three with high DNAaemia have been retransplanted. Five patients with low and two with high DNAaemia have died subsequently. No patient or graft was lost due to CMV.
Most CMV-seropositive liver recipients did not develop CMV reactivation, and if reactivations occurred, most were temporal, low-level DNAaemias. Significant CMV infections were successfully treated and recurrences were rare.
巨细胞病毒（CMV）是肝移植后的一种重要感染因子。为预防 CMV，大多数中心对 CMV 血清阴性受体/阳性供体高危人群进行预防治疗，甚至对许多血清阳性受体也进行预防治疗。然而，对于血清阳性患者，通常采用抢先治疗策略。
对采用抢先策略的 CMV 血清阳性成人肝移植患者进行前瞻性、长期随访。
通过实时定量血浆聚合酶链反应（PCR）对 CMV 血清阳性肝移植受者进行 CMV 监测，并接受更昔洛韦/缬更昔洛韦抢先治疗。将 161 例随访时间超过 4 年的患者纳入本研究。
大多数情况下（98/161，61%）未检测到 CMV，但 63/161（39%）患者在移植后 49 天（7-183 天）出现 CMV-DNA 血症。只有 25/63 例再激活超过 5000 拷贝/ml，这是根据所采用方法（中位数 21500，范围 5100-813300 拷贝/ml）将抢先治疗作为截止值时确定的，大多数为自限性、低水平 DNA 血症（中位数 850，范围 234-4000 拷贝/ml）。因此，38/161 例患者（23.5%）出现低水平、暂时性 CMV 病毒血症，只有 25/161 例（15.5%）表现出明显的病毒载量。1 例低水平 DNA 血症患者和 11 例高水平 DNA 血症患者中出现复发性 CMV，其中仅 5/11 例患者超过 5000 拷贝/ml。用更昔洛韦/缬更昔洛韦成功治疗了 CMV 感染。4 例低水平 DNA 血症患者和 3 例高水平 DNA 血症患者接受了再次肝移植。5 例低水平 DNA 血症患者和 2 例高水平 DNA 血症患者随后死亡。没有患者或移植物因 CMV 而丢失。
大多数 CMV 血清阳性肝移植受者未发生 CMV 再激活，如果发生再激活，大多数为暂时性、低水平 DNA 血症。显著的 CMV 感染得到了成功治疗，且复发较为罕见。
