García-Masedo Fernández Sarela, Laporta Rosalía, García Fadul Christian, Aguilar Pérez Myriam, Anel Pedroche Jorge, Sanabrias Fernández de Sevilla Raquel, Royuela Ana, Sánchez Romero Isabel, Ussetti Gil María Piedad
Microbiology Department, Hospital Universitario Puerta de Hierro, 28222 Majadahonda, Spain.
Pneumology Department, Hospital Universitario Puerta de Hierro, 28222 Majadahonda, Spain.
Microorganisms. 2024 Nov 19;12(11):2360. doi: 10.3390/microorganisms12112360.
(1) The prevention of cytomegalovirus (CMV) in lung transplant recipients (LTx) is based on the administration of VGC for a period of 6-12 months, but there is little information on the premature discontinuation of the drug. Our objective was to evaluate the reasons for early cessation of VGC and the dynamics of CMV replication after discontinuation. (2) We carried out a retrospective study of LTx on VGC prophylaxis according to guidelines, with an outpatient follow-up period of >90 days. The detection of any level of CMV-DNA in the plasma (Cobas, Roche Diagnostics) during a period of 18 months after the discontinuation of VGC was considered positive. (3) We included 312 patients (64% male, mean age 53.50 ± 12.27; 71% D+R+, 15% D-R+, and 14% D+R-) in our study. The prescribed prophylaxis was completed by 179 patients (57.05%). The mean duration of prophylaxis was 7.17 ± 1.08 months. The recorded reasons for VGC discontinuation in 133 patients (43%) were myelotoxicity (n = 55), impaired renal function (n = 32), and gastrointestinal disturbances (n = 11). The reason for discontinuation was not recorded for 29 patients. CMV-DNA was detected in 79% (n = 246) of cases, and D+R+ and D+R- recipients showed a high risk of detection ( < 0.001). The median times to onset of CMV-DNA detection were 35 days in D+R-, 73 days in D+R+, and 96 days in D-R+ ( < 0.001). (4) Adverse effects of VGC are frequent in LTx. CMV-DNA detection is very common after the discontinuation of VGC and is related to the CMV donor and recipient serostatus.
(1) 肺移植受者（LTx）巨细胞病毒（CMV）的预防基于给予缬更昔洛韦（VGC）6至12个月，但关于该药物过早停药的信息很少。我们的目的是评估VGC提前停药的原因以及停药后CMV复制的动态变化。(2) 我们根据指南对接受VGC预防的LTx患者进行了一项回顾性研究，门诊随访期超过90天。VGC停药后18个月内血浆中任何水平的CMV-DNA检测（Cobas，罗氏诊断公司）被视为阳性。(3) 我们的研究纳入了312例患者（64%为男性，平均年龄53.50±12.27岁；71%为D+R+，15%为D-R+，14%为D+R-）。179例患者（57.05%）完成了规定的预防。预防的平均持续时间为7.17±1.08个月。133例患者（43%）记录的VGC停药原因是骨髓毒性（n = 55）、肾功能损害（n = 32）和胃肠道紊乱（n = 11）。29例患者未记录停药原因。79%（n = 246）的病例检测到CMV-DNA，D+R+和D+R-受者检测风险较高（<0.001）。D+R-受者CMV-DNA检测的中位发病时间为35天，D+R+为73天，D-R+为96天（<0.001）。(4) VGC的不良反应在LTx中很常见。VGC停药后CMV-DNA检测非常普遍，并且与CMV供体和受体血清学状态有关。
