Piloni Davide, Gabanti Elisa, Morosini Monica, Cassinelli Gabriela, Frangipane Vanessa, Zavaglio Federica, Oggionni Tiberio, Saracino Laura, Lettieri Sara, Arbustini Eloisa, Meloni Federica, Lilleri Daniele
Pneumology Unit, Internal Medicine and Infectious Diseases Department, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy.
Molecular Virology Unit, Microbiology and Virology Department, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy.
Microorganisms. 2022 Nov 25;10(12):2339. doi: 10.3390/microorganisms10122339.
The efficacy of pre-emptive therapy in the prevention of cytomegalovirus (CMV) disease and the potential association of CMV infection with the occurrence of chronic lung allograft dysfunction (CLAD) was evaluated in 129 lung transplant recipients receiving pre-emptive therapy based on pp65-antigenemia or CMV-DNA in the blood and in the bronchoalveolar lavage. Seventy-one (55%) patients received pre-emptive ganciclovir/valganciclovir (GCV/VGCV) for CMV infection for a median of 28 (9-191) days. Possible CMV disease occurred in six (5%) patients and was healed after the GCV/VGCV therapy. The cumulative incidence of CLAD was 38% and 54% at 5 and 10 years. Acute rejection and CMV load in the blood (but not in the lung) were independent predictors of the occurrence of CLAD. Pre-emptive therapy is highly effective in preventing CMV disease in lung recipients and does not induce a superior incidence of CLAD compared to what reported for other cohorts of patients who received an extended antiviral prophylaxis.
在129例接受基于血液和支气管肺泡灌洗中pp65抗原血症或CMV-DNA的抢先治疗的肺移植受者中,评估了抢先治疗在预防巨细胞病毒(CMV)疾病方面的疗效以及CMV感染与慢性肺移植功能障碍(CLAD)发生之间的潜在关联。71例(55%)患者因CMV感染接受了抢先更昔洛韦/缬更昔洛韦(GCV/VGCV)治疗,中位治疗时间为28(9 - 191)天。6例(5%)患者发生了可能的CMV疾病,在接受GCV/VGCV治疗后痊愈。CLAD的累积发生率在5年和10年时分别为38%和54%。血液(而非肺组织)中的急性排斥反应和CMV载量是CLAD发生的独立预测因素。抢先治疗在预防肺移植受者的CMV疾病方面非常有效,与接受延长抗病毒预防的其他患者队列相比,CLAD的发生率并未更高。