Kervan Umit, Kucuker Seref Alp, Kocabeyoglu Sinan Sabit, Unal Ertekin Utku, Ozatik Mehmet Ali, Sert Dogan Emre, Kavasoglu Kemal, Tezer Ayse Yasemin, Pac Mustafa
From the Department of Cardiovascular Surgery, Turkey Yuksek Ihtisas Hospital, Ankara, Turkey.
Exp Clin Transplant. 2016 Oct;14(5):551-554. doi: 10.6002/ect.2015.0109. Epub 2016 Mar 14.
Cytomegalovirus infection is a major cause of morbidity and mortality in solid-organ transplant. Low doses of valacyclovir have been administered as cytomegalovirus prophylaxis in our institution for years. To the best of our knowledge, there is no published study of a low-dose regimen for cytomegalovirus prophylaxis in heart transplant patients. Therefore, our aim was to determine the results of low doses of valacyclovir in heart transplant.
Between September 2006 and December 2014, sixty-eight patients underwent orthotopic heart transplants. All of the patients received triple immunosuppressive therapy after surgery. During the next 6 months, sulfamethoxazole/trimethoprim was administered for Pneumocystis jiroveci pneumonia, and toxoplasmosis. Additionally all patients received valacyclovir hydrochloride (1000 mg/d, oral) for cytomegalovirus prophylaxis and nystatin oral rinse for prophylaxis of fungal infections.
There was only 1 cytomegalovirus infection at follow-up. The patient had cytomegalovirus pneumonia at 17-month follow-up. In response to treatment with 1-week intravenous ganciclovir, the patient was discharged with a further 6-month oral valacyclovir therapy (1000 mg/d).
In this study, we hypothesized that daily use of low-dose valacyclovir (1000 mg/d) is not only sufficient for cytomegalovirus prophylaxis but also beneficial in terms of cost.
巨细胞病毒感染是实体器官移植中发病和死亡的主要原因。多年来，我院一直使用低剂量伐昔洛韦进行巨细胞病毒预防。据我们所知，尚无关于心脏移植患者低剂量巨细胞病毒预防方案的已发表研究。因此，我们的目的是确定低剂量伐昔洛韦在心脏移植中的效果。
2006年9月至2014年12月期间，68例患者接受了原位心脏移植。所有患者术后均接受三联免疫抑制治疗。在接下来的6个月里，给予磺胺甲恶唑/甲氧苄啶预防耶氏肺孢子菌肺炎和弓形虫病。此外，所有患者均接受盐酸伐昔洛韦（1000mg/d，口服）预防巨细胞病毒感染，并使用制霉菌素口腔含漱液预防真菌感染。
随访期间仅发生1例巨细胞病毒感染。该患者在17个月随访时发生巨细胞病毒肺炎。经1周静脉注射更昔洛韦治疗后，患者出院，并继续接受6个月的口服伐昔洛韦治疗（1000mg/d）。
在本研究中，我们假设每日使用低剂量伐昔洛韦（1000mg/d）不仅足以预防巨细胞病毒感染，而且在成本方面也有益。
