Valenza M, Czer L S, Pan S H, Aleksic I, Freimark D, Harasty D A, Admon D, Barath P, Blanche C, Trento A
Division of Cardiothoracic Surgery, Cedars-Sinai Medical Center, Los Angeles 90048, USA.
J Heart Lung Transplant. 1995 Jul-Aug;14(4):659-65.
Cytomegalovirus is a frequent cause of infection and morbidity after heart transplantation, especially in patients treated with antilymphocytic drugs where the incidence may be as high as 50%.
To determine the efficacy of combined antiviral and intravenous immune globulin therapy for prevention of cytomegalovirus disease in transplant recipients receiving OKT3 and to compare two different antiviral drug regimens, we reviewed 115 transplant recipients from December 1988 to December 1993 who survived for more than 30 days. Of these, 29 received oral acyclovir for 3 months (group A) and 86 received intravenous ganciclovir for 2 weeks followed by oral acyclovir up to 3 months (group G); all received six infusions of 5% intravenous immune globulin over 2 months. All patients had OKT3 for 10 to 14 days and triple-drug immunosuppression.
Cytomegalovirus disease (pneumonitis, gastroenteritis, or leukopenia with fever) occurred in 10% of patients (12 of 115 patients) and was confirmed by positive culture, typical microscopic inclusions, or polymerase chain reaction. In 91 seropositive recipients, there was a trend to less cytomegalovirus disease in group G (3.0%, 2 of 67 patients) than in group A (12.5%, 3 of 24 patients) (p = 0.11), which was more apparent in recipients with seropositive donors where the incidence was reduced from 16.7% (group A) to 2.4% (group G; p = 0.08). In 24 seronegative recipients, cytomegalovirus disease incidence was higher overall and not significantly less in group G (26%, 5 of 19 patients) than in group A (40%, two of five patients) (p = Not significant).
Prophylaxis with combined antiviral and immune globulin therapy produces a low (10%) incidence of cytomegalovirus disease in OKT3-treated heart transplant recipients. In seropositive recipients treated with combined therapy, ganciclovir may be more effective than acyclovir. Larger trials and more aggressive prophylactic strategies are needed in seronegative patients who receive hearts from seropositive donors.
巨细胞病毒是心脏移植后感染及发病的常见原因，尤其在接受抗淋巴细胞药物治疗的患者中，其发病率可能高达50%。
为确定抗病毒与静脉注射免疫球蛋白联合治疗预防接受OKT3的移植受者巨细胞病毒病的疗效，并比较两种不同的抗病毒药物方案，我们回顾了1988年12月至1993年12月存活超过30天的115例移植受者。其中，29例接受口服阿昔洛韦3个月（A组），86例接受静脉注射更昔洛韦2周，随后口服阿昔洛韦直至3个月（G组）；所有患者在2个月内接受6次5%静脉注射免疫球蛋白输注。所有患者接受OKT3治疗10至14天，并采用三联药物免疫抑制。
巨细胞病毒病（肺炎、胃肠炎或伴有发热的白细胞减少症）发生于10%的患者（115例患者中的12例），并经阳性培养、典型显微镜下包涵体或聚合酶链反应证实。在91例血清学阳性受者中，G组（3.0%，67例患者中的2例）的巨细胞病毒病发生率有低于A组（12.5%，24例患者中的3例）的趋势（p = 0.11），在供者血清学阳性的受者中更为明显，其发生率从16.7%（A组）降至2.4%（G组；p = 0.08）。在24例血清学阴性受者中，巨细胞病毒病总体发生率更高，G组（26%，19例患者中的5例）并不显著低于A组（40%，5例患者中的2例）（p = 无显著性差异）。
抗病毒与免疫球蛋白联合治疗预防在接受OKT3治疗的心脏移植受者中产生较低（10%）的巨细胞病毒病发生率。在接受联合治疗的血清学阳性受者中，更昔洛韦可能比阿昔洛韦更有效。对于接受来自血清学阳性供者心脏的血清学阴性患者，需要进行更大规模的试验和更积极的预防策略。
