Stratta R J, Shaefer M S, Markin R S, Wood R P, Kennedy E M, Langnas A N, Reed E C, Woods G L, Donovan J P, Pillen T J
Department of Surgery, University of Nebraska Medical Center, Omaha 68105.
Arch Surg. 1989 Dec;124(12):1443-9; discussion 1449-50. doi: 10.1001/archsurg.1989.01410120093018.
During a 43-month period, we performed 248 liver transplantations in 211 patients (127 adults and 84 children). Cytomegalovirus (CMV) disease was documented in 73 recipients (34.6%). Risk factors for CMV disease included donor CMV seropositivity, antilymphocyte therapy, and retransplantation. The mean time of occurrence of CMV disease was 38.3 days after transplantation, and the most frequent site of disease was the hepatic allograft. A total of 69 patients were treated with intravenous ganciclovir, with a prompt and lasting response documented in 51 (73.9%). The remaining 18 (26.1%) developed recurrent CMV disease, which was more common after primary CMV exposure. Cytomegalovirus disease was ultimately controlled by ganciclovir in 94.2% of cases. This disease occurs early after transplantation and can be related to well-defined risk factors. Although ganciclovir therapy is effective, preliminary experience with prophylaxis shows promise in reducing the incidence of CMV disease.
在43个月的时间里，我们对211例患者（127例成人和84例儿童）进行了248例肝移植手术。73例受者（34.6%）出现了巨细胞病毒（CMV）疾病。CMV疾病的危险因素包括供体CMV血清学阳性、抗淋巴细胞治疗和再次移植。CMV疾病的平均发生时间为移植后38.3天，最常见的发病部位是肝脏移植器官。共有69例患者接受了静脉注射更昔洛韦治疗，其中51例（73.9%）有迅速且持久的反应记录。其余18例（26.1%）出现复发性CMV疾病，在原发性CMV暴露后更为常见。更昔洛韦最终控制了94.2%病例中的CMV疾病。这种疾病在移植后早期发生，可能与明确的危险因素有关。尽管更昔洛韦治疗有效，但预防性治疗的初步经验显示在降低CMV疾病发生率方面有前景。
