Transplant Research Center and Division of Nephrology, Department of Internal Medicine, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea.
Korean J Intern Med. 2019 Mar;34(2):375-382. doi: 10.3904/kjim.2017.040. Epub 2017 Dec 15.
BACKGROUND/AIMS: Anti-thymocyte globulin (ATG) treatment for acute T-cell mediated rejection (TCMR) can increase the risk of cytomegalovirus (CMV) infection. We aimed to evaluate the effect of valacyclovir prophylaxis against CMV infection after ATG administration as anti-rejection therapy.
We retrospectively analyzed 55 kidney transplant recipients (KTRs) receiving ATG for steroid resistant TCMR. In all KTRs, we used intravenous ganciclovir during ATG injection. In 34 KTRs treated before July 2013, we performed preemptive therapy for CMV infection after ATG therapy. They were regarded as the historic control group (CONT). After July 2013, we used valacyclovir maintenance for 1 month after ATG therapy in 21 patients (VAL). The primary outcome was the incidence of CMV infection, and the secondary outcomes were subsequent acute rejection, and graft and patient outcome.
Valacyclovir prophylaxis significantly reduced the incidence of CMV infection (VAL, 9.6% vs. CONT, 67.6%; p < 0.001), and CMV-free survival rate was higher in the VAL group compared to the CONT group (p = 0.009). In the VAL group, two cases of CMV infection were limited to CMV viremia, but CMV disease or syndrome (n = 3) was detected in the CONT group. There was no difference in graft failure (CONT, 70.5% vs. VAL, 47.6%; p = 0.152), incidence of subsequent rejection after ATG treatment (CONT, 41.1% vs. VAL, 33.3%; p = 0.776), and graft or patient survival between the two groups. There were no major adverse events associated with valacyclovir prophylaxis.
In conclusion, valacyclovir prophylaxis is effective in the prevention of CMV infection after ATG treatment for steroid resistant TCMR.
背景/目的：抗胸腺细胞球蛋白（ATG）治疗急性 T 细胞介导的排斥反应（TCMR）会增加巨细胞病毒（CMV）感染的风险。我们旨在评估 ATG 给药后预防性使用伐昔洛韦预防 CMV 感染作为抗排斥反应治疗的效果。
我们回顾性分析了 55 例因激素耐药性 TCMR 接受 ATG 治疗的肾移植受者（KTR）。所有 KTR 在接受 ATG 注射期间均接受静脉注射更昔洛韦。在 2013 年 7 月之前接受治疗的 34 例 KTR 中，我们在 ATG 治疗后对 CMV 感染进行了预防性治疗。他们被视为历史对照组（CONT）。2013 年 7 月之后，我们在 21 例患者（VAL）中在 ATG 治疗后使用伐昔洛韦维持治疗 1 个月。主要结局是 CMV 感染的发生率，次要结局是后续急性排斥反应以及移植物和患者的结局。
伐昔洛韦预防显著降低了 CMV 感染的发生率（VAL，9.6% vs. CONT，67.6%；p<0.001），VAL 组的 CMV 无感染生存率高于 CONT 组（p=0.009）。在 VAL 组中，有两例 CMV 感染仅限于 CMV 病毒血症，但在 CONT 组中发现了 CMV 疾病或综合征（n=3）。两组之间在移植物失功方面没有差异（CONT，70.5% vs. VAL，47.6%；p=0.152）、ATG 治疗后发生后续排斥反应的发生率（CONT，41.1% vs. VAL，33.3%；p=0.776）以及移植物或患者的生存率。伐昔洛韦预防没有与重大不良事件相关。
总之，伐昔洛韦预防在预防激素耐药性 TCMR 患者 ATG 治疗后 CMV 感染方面是有效的。
