肝移植后预防巨细胞病毒感染的两种策略。
Two strategies for prevention of cytomegalovirus infections after liver transplantation.
作者信息
Simon Philipp, Sasse Max, Laudi Sven, Petroff David, Bartels Michael, Kaisers Udo X, Bercker Sven
机构信息
Philipp Simon, Max Sasse, Sven Laudi, Udo X Kaisers, Sven Bercker, Department of Anesthesia and Intensive Care Medicine, Medical Faculty, University of Leipzig, 04103 Leipzig, Germany.
出版信息
World J Gastroenterol. 2016 Mar 28;22(12):3412-7. doi: 10.3748/wjg.v22.i12.3412.
AIM
To analyze differences in patients' clinical course, we compared two regimes of either preemptive therapy or prophylaxis after liver transplantation.
METHODS
This retrospective study was reviewed and approved by the institutional review board of the University of Leipzig. Cytomegalovirus (CMV) prophylaxis with valganciclovir hydrochloride for liver transplant recipients was replaced by a preemptive strategy in October 2009. We retrospectively compared liver transplant recipients 2 years before and after October 2009. During the first period, all patients received valganciclovir daily. During the second period all patients included in the analysis were treated following a preemptive strategy. Outcomes included one year survival and therapeutic intervention due to CMV viremia or infection.
RESULTS
Between 2007 and 2010 n = 226 patients underwent liver transplantation in our center. n = 55 patients were D(+)/R(-) high risk recipients and were excluded from further analysis. A further 43 patients had to be excluded since CMV prophylaxis/preemptive strategy was not followed although there was no clinical reason for the deviation. Of the remaining 128 patients whose data were analyzed, 60 received prophylaxis and 68 were treated following a preemptive strategy. The difference in overall mortality was not significant, nor was it significant for one-year mortality where it was 10% (95%CI: 8%-28%, P = 0.31) higher for the preemptive group. No significant differences in blood count abnormalities or the incidence of sepsis and infections were observed other than CMV. In total, 19 patients (14.7%) received ganciclovir due to CMV viremia and/or infections. Patients who were treated according to the preemptive algorithm had a significantly higher rate risk of therapeutic intervention with ganciclovir [n = 16 (23.5%) vs n = 3 (4.9%), P = 0.003)].
CONCLUSION
These data suggest that CMV prophylaxis is superior to a preemptive strategy in patients undergoing liver transplantation.
目的
为分析患者临床病程的差异，我们比较了肝移植后先发治疗或预防的两种方案。
方法
本回顾性研究经莱比锡大学机构审查委员会审核并批准。2009年10月，肝移植受者的盐酸缬更昔洛韦巨细胞病毒（CMV）预防方案被先发策略取代。我们回顾性比较了2009年10月前后2年的肝移植受者。在第一阶段，所有患者每日接受缬更昔洛韦治疗。在第二阶段，纳入分析的所有患者均按照先发策略进行治疗。观察指标包括一年生存率以及因CMV病毒血症或感染而进行的治疗干预。
结果
2007年至2010年期间，本中心有n = 226例患者接受了肝移植。n = 55例患者为D（+）/R（-）高风险受者，被排除在进一步分析之外。另有43例患者因未遵循CMV预防/先发策略而被排除，尽管没有临床理由解释这种偏差。在其余128例进行数据分析的患者中，60例接受了预防治疗，68例按照先发策略进行治疗。总体死亡率差异不显著，一年死亡率差异也不显著，先发治疗组的一年死亡率高10%（95%CI：8%-28%，P = 0.31）。除CMV外，未观察到血细胞计数异常、败血症和感染发生率的显著差异。共有19例患者（14.7%）因CMV病毒血症和/或感染接受了更昔洛韦治疗。按照先发算法治疗的患者接受更昔洛韦治疗干预的风险显著更高[n = 16（23.5%）对n = 3（4.9%），P = 0.003]。
结论
这些数据表明，在肝移植患者中，CMV预防优于先发策略。
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