儿童肾移植中的巨细胞病毒感染及（缬）更昔洛韦化学预防的影响

Cytomegalovirus Infection in Pediatric Renal Transplantation and the Impact of Chemoprophylaxis With (Val-)Ganciclovir.

作者信息

Höcker Britta, Zencke Sebastian, Krupka Kai, Fichtner Alexander, Pape Lars, Dello Strologo Luca, Guzzo Isabella, Topaloglu Rezan, Kranz Birgitta, König Jens, Bald Martin, Webb Nicholas J A, Noyan Aytül, Dursun Hasan, Marks Stephen, Yalcinkaya Fatos, Thiel Florian, Billing Heiko, Pohl Martin, Fehrenbach Henry, Bruckner Thomas, Tönshoff Burkhard

机构信息

1 Department of Pediatrics I, University Children's Hospital, Heidelberg, Germany. 2 Hanover Medical School, Hanover, Germany. 3 IRCCS Ospedale Pediatrico Bambino Gesù, Rome, Italy. 4 Faculty of Medicine, Department of Pediatric Nephrology, Hacettepe University, Ankara, Turkey. 5 University Children's Hospital, Department of General Pediatrics, Pediatric Nephrology, Münster, Germany. 6 Olga Children's Hospital, Clinic of Stuttgart, Stuttgart, Germany. 7 Royal Manchester Children's Hospital, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Center, Manchester, United Kingdom. 8 Baskent University, Adana Teaching and Research Center, Department of Pediatric Nephrology, Adana, Turkey. 9 Great Ormond Street Hospital, Great Ormond Street, London, United Kingdom. 10 Ankara University Faculty of Medicine, Dikimevi, Ankara, Turkey. 11 University Children's Hospital, Hamburg, Germany. 12 University Children's Hospital, Tübingen, Germany. 13 University Children's Hospital, Freiburg, Germany. 14 Children's Hospital, Memmingen, Germany. 15 Institute of Medical Biometry and Informatics, University of Heidelberg, Heidelberg, Germany.

出版信息

Transplantation. 2016 Apr;100(4):862-70. doi: 10.1097/TP.0000000000000888.

DOI:10.1097/TP.0000000000000888

PMID:26736017

Abstract

BACKGROUND

Cytomegalovirus (CMV) replication and disease, with its associated morbidity and poor transplant outcome, represents a serious threat to transplant recipients. The pediatric kidney transplant population is at a particularly increased risk of CMV infection.

METHODS

We therefore analyzed CMV epidemiology in a large cohort of pediatric renal transplant recipients (n = 242) and assessed the impact of antiviral chemoprophylaxis with valganciclovir (VGCV) or ganciclovir (GCV) on CMV replication and morbidity.

RESULTS

While antiviral chemoprophylaxis with VGCV or GCV in patients with a high (D+/R-) or intermediate (D+/R+) CMV risk (n = 82) compared to preemptive therapy (n = 47) had no significant effect on the incidence of CMV syndrome or tissue-invasive disease, chemoprophylaxis was associated with a better preservation of transplant function at 3 years posttransplant (loss of estimated glomerular filtration rate in the chemoprophylaxis cohort, 16.0 ± 3.4 vs. 30.1 ± 4.7 mL/min per 1.73 m(2) in the preemptive therapy cohort, P < 0.05).CMV replication was associated with a more pronounced decline of graft function (difference in estimated glomerular filtration rate of 9.6 mL/min per 1.73 m(2) at 3 years) compared to patients without CMV replication. However, patients undergoing VGCV or GCV chemoprophylaxis had more leukocytopenia.

CONCLUSION

Antiviral chemoprophylaxis with VGCV or GCV in recipients with a high or moderate CMV risk is associated with a better preservation of transplant function. Hence, the prevention of CMV replication in this patient population has the potential to improve transplant outcome.

摘要

背景

巨细胞病毒（CMV）复制及相关疾病，连同其伴随的发病率和不良移植结局，对移植受者构成严重威胁。小儿肾移植人群感染CMV的风险尤其高。

方法

因此，我们分析了一大群小儿肾移植受者（n = 242）中的CMV流行病学情况，并评估了使用缬更昔洛韦（VGCV）或更昔洛韦（GCV）进行抗病毒化学预防对CMV复制和发病率的影响。

结果

与抢先治疗组（n = 47）相比，在CMV高风险（D + /R -）或中度风险（D + /R +）的患者（n = 82）中，使用VGCV或GCV进行抗病毒化学预防对CMV综合征或组织侵袭性疾病的发生率没有显著影响，但化学预防与移植后3年移植肾功能的更好保留相关（化学预防组估计肾小球滤过率的损失为16.0±3.4，而抢先治疗组为30.1±4.7 mL/min per 1.73 m(2)，P < 0.05）。与无CMV复制的患者相比，CMV复制与移植肾功能更明显的下降相关（3年时估计肾小球滤过率差异为9.6 mL/min per 1.73 m(2)）。然而，接受VGCV或GCV化学预防的患者白细胞减少症更多。