在类固醇节约型肝移植中心，巨细胞病毒血症的发生及危险因素。
Incidence and risk factors for the development of cytomegalovirus viremia in a steroid sparing liver transplant center.
机构信息
Department of Pharmacy Practice, University of Illinois at Chicago College of Pharmacy, Chicago, Illinois, USA.
Center for Transplantation, University of California San Diego Health, San Diego, California, USA.
出版信息
Transpl Infect Dis. 2022 Aug;24(4):e13867. doi: 10.1111/tid.13867. Epub 2022 Jun 1.
BACKGROUND
Cytomegalovirus (CMV) is a common opportunistic infection in patients after liver transplant (LT). Guidelines recommend 900 mg daily of valganciclovir; however, valganciclovir commonly causes dose-dependent hematologic toxicities. Use of a low-dose valganciclovir (450 mg) has been used to prevent these adverse effects, but the data regarding this dosing strategy are not as robust in a steroid sparing LT center.
METHODS
Retrospective chart review of adult LT recipients between January 1, 2008 and June 30, 2019. All patients received low-dose valganciclovir 450 mg PO daily for CMV prophylaxis. Primary outcome was the incidence of CMV viremia in LT recipients at 12 months post-LT. Secondary outcomes include time to CMV viremia, risk factors for the development of CMV viremia, and incidence of breakthrough CMV viremia while on valganciclovir prophylaxis.
RESULTS
A total of 266 patients were included. Overall, the majority were male (63.2%) and Caucasian (45.5%). The most common indication for transplant was decompensated cirrhosis (82%). The incidence of CMV at 1 year posttransplant was 7.9%. Independent risk factors included high risk status (OR 5.97, 95% CI 2.14-16.61, p = .001) as well as having an episode of rejection (OR 5.99, 95% CI 2.16-16.66, p = .001).
CONCLUSION
Low-dose valganciclovir can be effective in the prevention of CMV viremia in LT patients and may be a beneficial strategy for CMV prophylaxis in a steroid-sparing transplant center. Further studies may be needed to determine appropriate length of prophylaxis therapy for different risk groups.
背景
巨细胞病毒（CMV）是肝移植（LT）后患者常见的机会性感染。指南建议每日使用 900mg 缬更昔洛韦；然而，缬更昔洛韦通常会引起剂量依赖性血液学毒性。使用低剂量缬更昔洛韦（450mg）已被用于预防这些不良反应，但在类固醇节约型 LT 中心，这种剂量方案的数据并不那么可靠。
方法
回顾性分析 2008 年 1 月 1 日至 2019 年 6 月 30 日期间成年 LT 受者的图表。所有患者均接受低剂量缬更昔洛韦 450mg PO 每日一次，用于 CMV 预防。主要结局是 LT 后 12 个月 LT 受者 CMV 血症的发生率。次要结局包括 CMV 血症的发生时间、CMV 血症发展的危险因素以及缬更昔洛韦预防期间突破性 CMV 血症的发生率。
结果
共纳入 266 例患者。总体而言，大多数患者为男性（63.2%）和白种人（45.5%）。移植的最常见指征是失代偿性肝硬化（82%）。移植后 1 年 CMV 的发生率为 7.9%。独立危险因素包括高危状态（OR 5.97，95%CI 2.14-16.61，p=0.001）和发生排斥反应（OR 5.99，95%CI 2.16-16.66，p=0.001）。
结论
低剂量缬更昔洛韦可有效预防 LT 患者的 CMV 血症，并且可能是类固醇节约型移植中心 CMV 预防的有益策略。可能需要进一步的研究来确定不同风险组的适当预防治疗时间。
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