Díaz Molina B, Velasco Alonso E, Lambert Rodríguez J L, Rodríguez Bernardo M J, Rozado Castaño J, Padrón Encalada R, Martín Fernández M, Pun Chinchai F, Colunga Blanco S, García Campos A
Department of Cardiology, Hospital Universitario Central de Asturias, Oviedo, Spain.
Department of Cardiology, Hospital Universitario Central de Asturias, Oviedo, Spain.
Transplant Proc. 2015 Jan-Feb;47(1):130-1. doi: 10.1016/j.transproceed.2014.11.026.
Viral infections, especially cytomegalovirus (CMV), are a leading cause of early death and morbidity after heart transplantation. Several strategies have been used to minimize the risk, including universal prophylaxis with ganciclovir or valganciclovir and preemptive therapy. Lately, everolimus (EVE) efficacy studies have shown a protective effect against CMV infection.
We studied retrospectively a series of 223 heart transplant patients, dividing them into 5 groups according to CMV prevention strategy: 16 patients were at low risk for infection (negative recipient [R-]/negative donor [D-]) and received no treatment; 26 patients received prophylactic therapy with ganciclovir, 8 patients prophylaxis with valganciclovir, 145 patients received preemptive therapy and 28 patients prophylaxis with valganciclovir and early conversion to EVE.
There were no cases of CMV infection in the low-risk group. There was 1 case of CMV infection in the group that received valganciclovir and conversion to EVE. Among the patients who received prophylaxis with ganciclovir or valganciclovir or preemptive therapy, CMV infection was detected in 68 patients (37%).
Early conversion to EVE in addition to valganciclovir prophylaxis was superior to other strategies in our series for the prevention of CMV infection.
病毒感染，尤其是巨细胞病毒（CMV）感染，是心脏移植后早期死亡和发病的主要原因。已经采用了多种策略来降低风险，包括使用更昔洛韦或缬更昔洛韦进行普遍预防以及抢先治疗。最近，依维莫司（EVE）疗效研究显示对CMV感染有保护作用。
我们回顾性研究了一系列223例心脏移植患者，根据CMV预防策略将他们分为5组：16例感染风险低的患者（受体阴性[R-]/供体阴性[D-]）未接受治疗；26例患者接受更昔洛韦预防性治疗，8例患者接受缬更昔洛韦预防性治疗，145例患者接受抢先治疗，28例患者接受缬更昔洛韦预防性治疗并早期转换为依维莫司治疗。
低风险组未发生CMV感染病例。接受缬更昔洛韦治疗并转换为依维莫司治疗的组中有1例CMV感染。在接受更昔洛韦或缬更昔洛韦预防性治疗或抢先治疗的患者中，68例（37%）检测到CMV感染。
在我们的系列研究中，除缬更昔洛韦预防外早期转换为依维莫司在预防CMV感染方面优于其他策略。
