Transplant and Immunocompromised Host Infectious Diseases Infectious Diseases Division, Massachusetts General Hospital, Harvard Medical School, Boston, MA.
Transplant Infectious Diseases and Multi-Organ Transplant Program, University Health Network, Toronto, Ontario, Canada.
Transplantation. 2018 Jun;102(6):900-931. doi: 10.1097/TP.0000000000002191.
Despite recent advances, cytomegalovirus (CMV) infections remain one of the most common complications affecting solid organ transplant recipients, conveying higher risks of complications, graft loss, morbidity, and mortality. Research in the field and development of prior consensus guidelines supported by The Transplantation Society has allowed a more standardized approach to CMV management. An international multidisciplinary panel of experts was convened to expand and revise evidence and expert opinion-based consensus guidelines on CMV management including prevention, treatment, diagnostics, immunology, drug resistance, and pediatric issues. Highlights include advances in molecular and immunologic diagnostics, improved understanding of diagnostic thresholds, optimized methods of prevention, advances in the use of novel antiviral therapies and certain immunosuppressive agents, and more savvy approaches to treatment resistant/refractory disease. The following report summarizes the updated recommendations.
尽管最近取得了进展,但巨细胞病毒 (CMV) 感染仍然是影响实体器官移植受者的最常见并发症之一,增加了并发症、移植物丢失、发病率和死亡率的风险。该领域的研究和由移植学会支持的先前共识指南的制定,使得对 CMV 管理可以采用更标准化的方法。一个由国际多学科专家组成的小组被召集来扩展和修改基于 CMV 管理的证据和专家意见的共识指南,包括预防、治疗、诊断、免疫学、耐药性和儿科问题。重点包括分子和免疫诊断学的进步、对诊断阈值的更深入理解、预防方法的优化、新型抗病毒治疗和某些免疫抑制剂的使用进展,以及对治疗抵抗/难治性疾病更明智的方法。以下报告总结了更新的建议。