Eriksson Mari, Jokinen Janne J, Söderlund Sanni, Hämmäinen Pekka, Lommi Jyri, Lemström Karl
Department of Medicine, Division of Infectious Diseases, Helsinki University Hospital, Helsinki, Finland.
Heart and Lung Transplantion Program, Heart and Lung Center, Helsinki University Hospital, Helsinki, Finland.
Transpl Infect Dis. 2018 Jun;20(3):e12868. doi: 10.1111/tid.12868. Epub 2018 Mar 31.
Cytomegalovirus (CMV) remains an important pathogen in solid organ transplant patients.
We executed a hybrid prophylactic and pre-emptive valganciclovir (VGCV) prophylaxis to prevent CMV infection in heart transplant patients with anti-thymocyte globulin (ATG) induction and retrospectively evaluated the efficacy and safety of this regimen.
Hundred adult heart transplant patients between 2004 and 2010 were included. Recipients with CMV serostatus D+/R- received VGCV 900 mg OD for 6 months and 94.2% (81/86) of R+ recipients received a low-dose 450 mg OD for 3 months. Blood CMV was monitored until 3 months after cessation of the prophylaxis.
All patients accomplished the prophylaxis. The overall incidence of CMV disease was 4% (4/100) and it was more frequent in D+/R- patients (P = .001). Three of eighty-six (3.5%) of R+ patients had CMV infection (one CMV disease) while on prophylaxis, 2/3 were still on the original significantly reduced renal dose though. There was one late CMV disease in both D+/R- and R+ groups. Ganciclovir/VGCV treatment was successful in all patients.
The hybrid strategy with low-dose VGCV in R+ patients with ATG was efficient and safe. The good treatment results indicate that the regimen did not lead to a clinically relevant resistance. Optimal renal dosage is essential throughout prophylaxis.
巨细胞病毒（CMV）仍是实体器官移植患者中的一种重要病原体。
我们实施了一种预防与抢先使用缬更昔洛韦（VGCV）相结合的预防措施，以预防接受抗胸腺细胞球蛋白（ATG）诱导治疗的心脏移植患者发生CMV感染，并对该方案的疗效和安全性进行回顾性评估。
纳入2004年至2010年间的100例成年心脏移植患者。CMV血清学状态为D+/R-的受者接受900mg每日一次的VGCV治疗6个月，94.2%（81/86）的R+受者接受低剂量450mg每日一次的治疗3个月。监测血液中的CMV直至预防措施停止后3个月。
所有患者均完成了预防措施。CMV疾病的总体发生率为4%（4/100），在D+/R-患者中更为常见（P = 0.001）。86例R+患者中有3例（3.5%）在预防期间发生CMV感染（1例CMV疾病），不过其中2/3仍在使用显著减少的初始肾剂量。D+/R-组和R+组均有1例迟发性CMV疾病。所有患者使用更昔洛韦/VGCV治疗均成功。
在接受ATG治疗的R+患者中采用低剂量VGCV的联合策略是有效且安全的。良好的治疗结果表明该方案未导致临床相关耐药性。在整个预防过程中，最佳肾剂量至关重要。
