肠移植中巨细胞病毒预防和治疗的国际调查。

An international survey of cytomegalovirus prevention and treatment practices in intestinal transplantation.

机构信息

1 Transplant Infectious Diseases Program, University of Nebraska Medical Center, Omaha, NE. 2 Transplant Surgery Division, University of Nebraska Medical Center, Omaha, NE. 3 Transplant Surgery, Cleveland Clinic, Cleveland, OH. 4 Biostatistics Department, University of Nebraska Medical Center, Omaha, NE. 5 Address correspondence to: Diana F. Florescu, M.D., Transplant Infectious Diseases Program, University of Nebraska Medical Center, 985400 Nebraska Medical Center, Omaha, NE 68198.

出版信息

Transplantation. 2014 Jan 15;97(1):78-82. doi: 10.1097/TP.0b013e3182a6baa2.

DOI:10.1097/TP.0b013e3182a6baa2

PMID:24092376

Abstract

BACKGROUND

Practice variation regarding cytomegalovirus (CMV) prevention and treatment across intestinal transplantation (IT) programs is unknown.

METHODS

An electronic survey was sent to IT programs registered with the Intestinal Transplant Association. Proportions were analyzed for categorical variables; means and SDs were analyzed for continuous variables.

RESULTS

Seventy-seven percent of IT programs responded to the survey. For CMV D+/R- recipients, 39.1% programs used universal prophylaxis (UP), 8.7% preemptive strategy (PE), and 52.2% hybrid strategy. For CMV R+ recipients, 45.8% programs used UP, 12.5% PE, 37.1% hybrid strategy, and 4.2% none. For CMV D-/R- recipients, 39.1% programs used UP, 21.7% PE, 26.1% hybrid strategy, and 13% none. Frequency of monitoring for PE was weekly 71.4% of programs, every 2 weeks 21.4%, and monthly 7.1%. For CMV viremia, syndrome and disease, the most common first-line agents used were ganciclovir (100% and 96.2%) and valganciclovir (23.1%) and the second-line agent was foscarnet (73.1% and 84.6%). Immunoglobulins were administered in 65.4% of the programs for pneumonia (69.2%), meningoencephalitis (50%), enteritis (46.2%), colitis (38.5%), syndrome (42.3%), viremia (30.8%), and resistant/refractory infections (11.5%).

CONCLUSIONS

Prophylaxis and hybrid strategy were the most commonly used. Treatment practices were consistent and mainly involved ganciclovir as first-line agent and foscarnet as second-line agent. The use of immunoglobulins appeared to be more common than in other allografts.

摘要

背景

关于巨细胞病毒（CMV）预防和治疗的实践差异在肠移植（IT）项目中尚不清楚。

方法

向肠移植协会注册的 IT 项目发送了电子调查。对分类变量进行了比例分析；对连续变量进行了平均值和标准差分析。

结果

77%的 IT 项目对调查做出了回应。对于 CMV D+/R-受者，39.1%的项目使用通用预防（UP），8.7%使用抢先策略（PE），52.2%使用混合策略。对于 CMV R+受者，45.8%的项目使用 UP，12.5%使用 PE，37.1%使用混合策略，4.2%的项目不使用。对于 CMV D-/R-受者，39.1%的项目使用 UP，21.7%使用 PE，26.1%使用混合策略，13%的项目不使用。PE 监测的频率为每周 71.4%的项目，每 2 周 21.4%，每月 7.1%。对于 CMV 病毒血症、综合征和疾病，最常用的一线药物是更昔洛韦（100%和 96.2%）和缬更昔洛韦（23.1%），二线药物是膦甲酸钠（73.1%和 84.6%）。65.4%的项目为肺炎（69.2%）、脑膜脑炎（50%）、肠炎（46.2%）、结肠炎（38.5%）、综合征（42.3%）、病毒血症（30.8%）和耐药/难治性感染（11.5%）使用免疫球蛋白。