肝移植后的巨细胞病毒再激活与抢先治疗。

Cytomegalovirus reactivation and preemptive therapy after liver transplant.

作者信息

Davoudi Setareh, Kasraianfard Amir, Ahmadinejad Zahra, Najafi Atabak, Salimi Javad, Makarem Jalil, Sohrabpour Amir Ali, Jafarian Ali

机构信息

Hepatobiliary and Liver Transplantation Research Center, Tehran University of Medical Sciences, Tehran, Iran.

出版信息

Exp Clin Transplant. 2014 Mar;12 Suppl 1:72-5.

PMID:24635797

Abstract

OBJECTIVES

Cytomegalovirus is the most common viral infection after orthotopic liver transplant. The purpose of the present study was to determine the incidence of cytomegalovirus reactivation in Iranian liver transplant recipients at our center and to evaluate outcomes with preemptive therapy with ganciclovir for pp65 antigenemia.

MATERIALS AND METHODS

There were 145 patients who had liver transplant and who survived > 2 weeks after transplant. All patients were evaluated for pp65 antigenemia weekly until 90 days after transplant. The diagnosis of cytomegalovirus reactivation was made when a recipient had pp65 antigenemia ≥ 1/50,000 leukocytes. In patients who had cytomegalovirus infection, preemptive therapy with ganciclovir (5 mg/kg, intravenous, twice daily) was started immediately after diagnosis and continued for ≥ 21 days and until cytomegalovirus antigen became undetectable on 2 consecutive tests.

RESULTS

All patients in our study were seropositive for cytomegalovirus before transplant. Follow-up at mean 27 ± 20 months (range, 5.2 to 80.6 mo) after transplant showed that 46 patients (32%) had cytomegalovirus reactivation at mean 56 ± 67 days after transplant (range, 12 to 445 d). There was a higher frequency of female patients in the cytomegalovirus reactivation than non-reactivation group (odds ratio, 2.3; P ≤ .02). The most common causes of liver failure in the cytomegalovirus reactivation group were autoimmune hepatitis, cryptogenic cirrhosis, and hepatitis B virus cirrhosis. There was no significant relation between cause of liver failure, use of steroids before or after transplant, and frequency of acute rejection and cytomegalovirus reactivation. Only 1 patient (2%) developed cytomegalovirus disease at 22 days after transplant, and this patient was treated successfully. There were 6 patients (13%) who developed a second episode of cytomegalovirus reactivation at median 43 days (range, 10 to 176 d) after the first episode; all 6 patients were treated successfully with ganciclovir.

CONCLUSIONS

Preemptive treatment with ganciclovir may be an effective approach against cytomegalovirus in seropositive recipients after liver transplant.

摘要

目的

巨细胞病毒是原位肝移植后最常见的病毒感染。本研究的目的是确定我们中心伊朗肝移植受者中巨细胞病毒再激活的发生率，并评估更昔洛韦针对pp65抗原血症进行抢先治疗的效果。

材料与方法

有145例接受肝移植且移植后存活超过2周的患者。所有患者在移植后90天内每周评估pp65抗原血症。当受者的pp65抗原血症≥1/50,000白细胞时，诊断为巨细胞病毒再激活。对于发生巨细胞病毒感染的患者，诊断后立即开始用更昔洛韦（5mg/kg，静脉注射，每日两次）进行抢先治疗，持续≥21天，直至连续两次检测不到巨细胞病毒抗原。

结果

我们研究中的所有患者移植前巨细胞病毒血清学均为阳性。移植后平均随访27±20个月（范围5.2至80.6个月）显示，46例患者（32%）在移植后平均56±67天（范围12至445天）出现巨细胞病毒再激活。巨细胞病毒再激活组女性患者的频率高于未再激活组（比值比，2.3；P≤0.02）。巨细胞病毒再激活组肝衰竭的最常见原因是自身免疫性肝炎、隐源性肝硬化和乙型肝炎病毒肝硬化。肝衰竭的原因、移植前后使用类固醇以及急性排斥反应的频率与巨细胞病毒再激活之间无显著关系。仅1例患者（2%）在移植后22天发生巨细胞病毒病，该患者治疗成功。有6例患者（13%）在首次发作后中位43天（范围10至176天）出现第二次巨细胞病毒再激活；所有6例患者用更昔洛韦治疗成功。