Grattan M T, Moreno-Cabral C E, Starnes V A, Oyer P E, Stinson E B, Shumway N E
Department of Cardiovascular Surgery, Stanford University Medical Center, CA 94305.
JAMA. 1989;261(24):3561-6.
We studied the effects of cytomegalovirus (CMV) infection on 301 cardiac transplant recipients who were treated during the cyclosporine era of immunosuppression (1980 to the present). These patients received varying combinations of cyclosporine, azathioprine, prednisone, rabbit antithymocyte globulin, and OKT3 as their immunosuppressive therapy. Two hundred ten patients were free of CMV infection (non-CMV group). During the same period CMV infection developed in 91 patients, as manifested by a fourfold IgG serologic titer rise, demonstration of CMV inclusion bodies in tissue, or positive cultures for the virus (CMV group). The rate of graft rejection was significantly higher in the CMV group. Graft atherosclerosis was significantly more severe in the CMV group as judged by angiographic criteria or by pathologic study. Patient survival rates were significantly lower in the CMV group. Death caused by graft atherosclerosis was significantly more common among patients in the CMV group. Finally, the graft loss rate (from either death or retransplantation for atherosclerosis) was significantly greater in the CMV group. These data demonstrate that CMV infection in cardiac transplant recipients is associated with more frequent rejection, graft atherosclerosis, and death.
我们研究了巨细胞病毒（CMV）感染对301例心脏移植受者的影响，这些患者在免疫抑制的环孢素时代（1980年至今）接受治疗。这些患者接受了环孢素、硫唑嘌呤、泼尼松、兔抗胸腺细胞球蛋白和OKT3的不同组合作为免疫抑制治疗。210例患者未发生CMV感染（非CMV组）。同期91例患者发生CMV感染，表现为IgG血清学滴度升高四倍、组织中出现CMV包涵体或病毒培养阳性（CMV组）。CMV组的移植物排斥率显著更高。根据血管造影标准或病理研究判断，CMV组的移植物动脉粥样硬化明显更严重。CMV组的患者生存率显著更低。CMV组患者中因移植物动脉粥样硬化导致的死亡明显更常见。最后，CMV组的移植物丢失率（因死亡或因动脉粥样硬化再次移植）显著更高。这些数据表明，心脏移植受者中的CMV感染与更频繁的排斥、移植物动脉粥样硬化和死亡相关。
