Department of Infectious Diseases and Intensive Care, University Hospital of Rennes, Rennes, France.
CIC-INSERM 1414, University Hospital of Rennes and University of Rennes, Rennes, France.
Transpl Infect Dis. 2024 Jun;26(3):e14282. doi: 10.1111/tid.14282. Epub 2024 Jun 2.
Prophylaxis (P) or pre-emptive strategy (PS) in high-risk liver transplant recipients (LTRs) are either recommended. We compared the results of each strategy.
Two groups of LTR transplanted during two consecutive periods were compared. Only cytomegalovirus (CMV)-mismatched LTR (Donor +/ Recipient -) were included. The primary endpoints were: the onset of polymerase chain reaction-based DNAemia and the proportion of patients with CMV disease. A number of episodes of CMV infection, antiviral therapy, ganciclovir resistance, infectious or immunological complications, cost of both strategies, and survival (1, 5, and 10 years) were also compared.
Forty-eight and 60 patients were respectively included in the P and PS groups. Eighteen (38%) in the P group and 56 (93%) in the PS group had CMV DNAemia (p <.0001) with a similar CMV disease rate (16.7% and 15%). Duration of curative therapy was longer in the PS group: 91 days versus 16 (p <.0001). Acute rejection was less frequent (p = .04) and more patients experienced a ganciclovir-resistant CMV infection in the PS group (10% vs. 0, p = .03). The drug-associated cost of PS was higher (10 004 vs. 4804€) and the median number of rehospitalization days tended to be higher (6 vs. 4, p = .06). Survival at any time was similar.
We reported more CMV DNAemias and ganciclovir-resistant CMV events with PS. The cost of the PS strategy was higher.
高风险肝移植受者（LTR）推荐采用预防（P）或先发制人的策略（PS）。我们比较了每种策略的结果。
比较了两个连续时期移植的两组 LTR。仅包括细胞巨化病毒（CMV）不匹配的 LTR（供体+/受体-）。主要终点是：基于聚合酶链反应的 DNA 血症发作和 CMV 疾病患者的比例。还比较了 CMV 感染、抗病毒治疗、更昔洛韦耐药、感染或免疫并发症的次数、两种策略的成本以及存活率（1、5 和 10 年）。
P 组和 PS 组分别纳入 48 例和 60 例患者。P 组有 18 例（38%）和 PS 组有 56 例（93%）发生 CMV DNA 血症（p<0.0001），CMV 疾病发生率相似（16.7%和 15%）。PS 组的治疗时间更长：91 天 vs 16 天（p<0.0001）。急性排斥反应较少（p=0.04），PS 组更昔洛韦耐药 CMV 感染患者更多（10% vs 0，p=0.03）。PS 策略的药物相关成本更高（10004 欧元 vs. 4804 欧元），再次住院天数中位数也较高（6 天 vs. 4 天，p=0.06）。任何时候的存活率相似。
我们报告了更多的 PS 后 CMV DNA 血症和更昔洛韦耐药的 CMV 事件。PS 策略的成本更高。
