Department of Virology, CHU Purpan, Toulouse, France.
J Med Virol. 2015 May;87(5):836-44. doi: 10.1002/jmv.23964. Epub 2015 Feb 5.
This study compared the pre-emptive and the prophylactic strategies used to prevent cytomegalovirus (CMV) infection and disease in CMV-seropositive orthotopic liver-transplant recipients and searched for associated predictive factors. Seventy-three orthotopic liver-transplant recipients who had received a transplant before November 2005 were given ganciclovir IV pre-emptively (group I) and 56 recipients who had received a transplant after November 2005 were given prophylactic valganciclovir for 3 months (group II). Demographic and biochemical parameters did not statistically vary between the groups at baseline. Monitoring of CMV DNAemia was similar in both groups. Forty-two (57.5%) patients presented with CMV infection in group I and 18 (32.1%) in group II (P < 0.004). CMV DNAemia was first detected at a median of 33 days post-transplant in group I and at 98.5 days in group II (P < 0.003), but viral loads were not significantly different. The overall incidence of CMV disease was 9.6% in group I versus 7.1% in group II (ns). Thirty-five (47.9%) patients presented with biopsy-proven acute rejection in group I and 13 (23.2%) in group II (P = 0.004). Forty (55%) patients in group I and 25 (44.6%) in group II presented with de novo post-transplant diabetes (P = 0.057). At 1-year post-transplant, global survival curves were not significantly different. Independent factors associated with CMV reactivation were an absence of CMV prophylaxis, CMV serological status of the donor, cold ischemia time, and HLA A + B + DR compatibility. CMV prophylaxis is efficacious and can prevent safely the direct and indirect effects of CMV infection in CMV-seropositive orthotopic liver-transplant recipients.
这项研究比较了用于预防 CMV（巨细胞病毒）感染和疾病的先发制人和预防策略，以确定相关的预测因素。73 名接受过 2005 年 11 月前移植的 CMV 血清阳性原位肝移植受者接受了 IV 更昔洛韦的先发制人治疗（I 组），56 名接受过 2005 年 11 月后移植的受者接受了 3 个月的预防性缬更昔洛韦治疗（II 组）。两组患者的基线人口统计学和生化参数无统计学差异。两组患者的 CMV DNA 血症监测相似。I 组有 42 名（57.5%）患者出现 CMV 感染，II 组有 18 名（32.1%）患者出现 CMV 感染（P < 0.004）。I 组患者的 CMV DNA 血症首次检测时间中位数为移植后 33 天，II 组为 98.5 天（P < 0.003），但病毒载量无显著差异。I 组的 CMV 疾病总发生率为 9.6%，II 组为 7.1%（无统计学意义）。I 组有 35 名（47.9%）患者出现经活检证实的急性排斥反应，II 组有 13 名（23.2%）患者出现经活检证实的急性排斥反应（P = 0.004）。I 组有 40 名（55%）患者和 II 组有 25 名（44.6%）患者出现新诊断的移植后糖尿病（P = 0.057）。移植后 1 年，两组患者的总生存率曲线无显著差异。与 CMV 再激活相关的独立因素包括无 CMV 预防、供体的 CMV 血清状态、冷缺血时间和 HLA A + B + DR 相容性。CMV 预防是有效的，可以安全地预防 CMV 血清阳性原位肝移植受者 CMV 感染的直接和间接影响。
