Metselaar H J, Weimar W
Department of Internal Medicine, University Hospital, Rotterdam-Dijkzigt, The Netherlands.
J Antimicrob Chemother. 1989 Jun;23 Suppl E:37-47. doi: 10.1093/jac/23.suppl_e.37.
Cytomegalovirus (CMV) infections remain a major clinical problem after renal transplantation. Reported incidences of CMV disease range from 17 to 25% in patients with azathioprine treatment and from 2 to 23% in patients on cyclosporin A. CMV-related death occurs in 1-3% of the total kidney transplant population. CMV seronegative kidney recipients of a transplant from a seropositive donor are especially at risk for primary infection as CMV can be transmitted by the transplant. In patients treated with antilymphocyte globulin (ALG) preparations for rejection, CMV disease is diagnosed three to four times more frequent than in patients without ALG therapy. Prevention of CMV infection is possible by selecting CMV seronegative donors for seronegative recipients. Active and passive immunization does not prevent CMV infection after renal transplantation, but immunoprophylaxis may result in less severe CMV disease. Effective treatment of clinical overt CMV disease is possible with the new guanine analogue ganciclovir. However, the use of this drug is associated with neutropenia, especially in patients with compromised kidney function. More pharmacokinetic data are needed to determine optimal dosing schemes.
肾移植后巨细胞病毒（CMV）感染仍然是一个主要的临床问题。接受硫唑嘌呤治疗的患者中，CMV疾病的报告发病率为17%至25%，接受环孢素A治疗的患者中为2%至23%。CMV相关死亡发生在肾移植总人群的1%至3%中。来自血清反应阳性供体的CMV血清反应阴性肾移植受者尤其有原发性感染的风险，因为CMV可通过移植传播。在接受抗淋巴细胞球蛋白（ALG）制剂治疗排斥反应的患者中，CMV疾病的诊断频率是未接受ALG治疗患者的三到四倍。通过为血清反应阴性受者选择CMV血清反应阴性供体，可以预防CMV感染。主动和被动免疫不能预防肾移植后的CMV感染，但免疫预防可能会使CMV疾病的严重程度降低。新型鸟嘌呤类似物更昔洛韦可以有效治疗临床显性CMV疾病。然而，使用这种药物会导致中性粒细胞减少，尤其是在肾功能受损的患者中。需要更多的药代动力学数据来确定最佳给药方案。
