辅助使用西多福韦和静脉注射免疫球蛋白治疗实体器官移植受者侵袭性腺病毒病。
Adjunctive Use of Cidofovir and Intravenous Immunoglobulin to Treat Invasive Adenoviral Disease in Solid Organ Transplant Recipients.
机构信息
Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland.
Department of Microbiology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
出版信息
Pharmacotherapy. 2018 Dec;38(12):1260-1266. doi: 10.1002/phar.2194. Epub 2018 Nov 26.
BACKGROUND
Infections with adenoviruses (ADVs) can result in considerable mortality and morbidity in solid organ transplant (SOT) recipients. Standard therapy for ADV infections in transplant recipients is not established. At our institution, intravenous cidofovir and immunoglobulin have been used to treat disseminated or invasive ADV in SOT and hematopoietic stem cell transplant recipients.
METHODS
A retrospective case series of SOT recipients treated with cidofovir and intravenous immunoglobulin was performed.
RESULTS
Five SOT recipients (four renal and one heart transplant) with adenovirus infection were treated successfully with cidofovir and immunoglobulin. Cidofovir was discontinued after the first negative ADV viral load and resolution of clinical symptoms, given the concern for nephrotoxicity in renal transplant recipients. Renal tubular acidosis type 2 and iritis were observed in two patients receiving therapy.
CONCLUSION
Symptom resolution and a single negative ADV viral load may be indicators for cidofovir discontinuation.
背景
腺病毒（ADV）感染可导致实体器官移植（SOT）受者死亡率和发病率显著升高。目前，针对移植受者 ADV 感染的标准治疗方法尚未建立。在本机构，已采用静脉注射更昔洛韦和免疫球蛋白治疗 SOT 和造血干细胞移植受者的播散性或侵袭性 ADV。
方法
对接受更昔洛韦和静脉注射免疫球蛋白治疗的 ADV 感染 SOT 受者进行了回顾性病例系列研究。
结果
5 例 ADV 感染的 SOT 受者（4 例肾移植和 1 例心脏移植）成功接受了更昔洛韦和免疫球蛋白治疗。由于担心肾移植受者发生肾毒性，在首次 ADV 病毒载量转为阴性且临床症状缓解后停止了更昔洛韦的使用。2 例接受治疗的患者出现 2 型肾小管性酸中毒和虹膜炎。
结论
症状缓解和 ADV 病毒载量转为阴性可能是停止更昔洛韦治疗的指标。
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