Centre for Clinical Research, Faculty of Medicine, University of Queensland, Royal Brisbane and Women's Hospital Campus, Brisbane, QLD, Australia.
Transplant and Immunocompromised Host Infectious Diseases, Infectious Diseases Division, Massachusetts General Hospital, Harvard Medical School, Boston, MA.
Transplantation. 2024 Apr 1;108(4):884-897. doi: 10.1097/TP.0000000000004855. Epub 2023 Oct 30.
Cytomegalovirus (CMV) is one of the most common infections occurring after solid organ transplantation. This high burden of disease, which incurs sizeable morbidity, may be worsening with the proportion of high-risk D+/R- solid organ transplantation recipients increasing in some regions globally. Cohort studies continue to support either universal prophylaxis or preemptive therapy as effective prevention strategies. Letermovir prophylaxis was noninferior to valganciclovir in adult high-risk D+/R- kidney transplant recipients with fewer drug-related adverse events in a recent clinical trial and has now been approved for such use in some regions. Maribavir preemptive therapy failed to demonstrate noninferiority when compared with valganciclovir in hematopoietic stem cell transplant recipients but looked promising for safety. Donor matching could be useful in prevention CMV disease with a survival advantage demonstrated in seronegative recipients waiting up to 30 mo for a seronegative kidney. Immune-guided prophylaxis resulted in fewer CMV infection episodes in lung transplant recipients when compared with fixed-duration prophylaxis in a recent clinical trial. For treatment of refractory or resistant CMV infection, maribavir was more efficacious and better tolerated when compared with investigator-initiated therapy in its registration trial for this condition. Further research regarding best treatment and prophylaxis of resistant or refractory CMV infection is needed to reflect best clinical practice choices. Optimal use of immune globulin or CMV-specific T cells for prevention or treatment of CMV disease remains undefined. Standardized definitions for the design of CMV clinical trials have been developed. In this review, we highlight recent updates in the field from data published since 2018.
巨细胞病毒（CMV）是实体器官移植后最常见的感染之一。这种高疾病负担会导致相当大的发病率，而且在全球某些地区，高风险 D+/R-实体器官移植受者的比例增加，可能会使情况恶化。队列研究继续支持普遍预防或抢先治疗作为有效的预防策略。在最近的一项临床试验中，来特莫韦预防与缬更昔洛韦相比在成人高风险 D+/R-肾移植受者中具有非劣效性，且具有较少的药物相关不良事件，现已在一些地区批准用于该用途。与缬更昔洛韦相比，马拉韦尔抢先治疗在造血干细胞移植受者中未能显示非劣效性，但在安全性方面似乎很有前途。供体匹配可能有助于预防 CMV 疾病，在等待阴性肾脏长达 30 个月的阴性受体中显示出生存优势。在最近的一项临床试验中，与固定疗程预防相比，免疫指导预防在肺移植受者中导致较少的 CMV 感染发作。对于治疗难治性或耐药性 CMV 感染，与注册试验中研究者发起的治疗相比，马拉韦尔在其注册试验中显示出更高的疗效和更好的耐受性。需要进一步研究耐药或难治性 CMV 感染的最佳治疗和预防方法，以反映最佳的临床实践选择。免疫球蛋白或 CMV 特异性 T 细胞用于预防或治疗 CMV 疾病的最佳使用仍然不确定。已经为 CMV 临床试验的设计制定了标准化定义。在这篇综述中，我们强调了自 2018 年以来发表的数据在该领域的最新进展。
