Balk A H, Weimar W, Rothbarth P H, Meeter K, Metselaar H J, Mochtar B, Simoons M L
Thoraxcenter, Hospital of the Erasmus University Rotterdam-Dijkzigt, The Netherlands.
Infection. 1993 Jul-Aug;21(4):195-200. doi: 10.1007/BF01728886.
We analyzed the results of passive immunization against CMV in 146 heart transplant recipients. The 65 seronegative recipients were prophylactically treated with anti-CMV immunoglobulins during and after the operation. Twenty-nine of these 65 patients received a seropositive donor heart. CMV infection occurred in 21/65 seronegative and in 40/81 seropositive recipients (difference not significant). The incidence of CMV infection in seronegative recipients of a CMV-matched donor heart (3/34) was significantly lower than in seronegative recipients of a positive donor heart and lower than in seropositive recipients, but no significant difference in infection rate was found between the two latter groups (18/29 vs. 40/81). Although primary infection more frequently resulted in CMV disease than secondary infection (11/21 vs. 10/40) no difference in incidence of disease was noted between seronegative and seropositive patients (11/65 vs. 10/81), nor was there a difference in the severity of symptoms following primary or secondary infection. There was a higher incidence of CMV disease in all patients who received a heart from a seropositive donor versus a seronegative donor. However, after transplantation of a heart from a seropositive donor the incidence (27%) of CMV disease observed in our passively immunized seronegative patients was the same as in the patients with naturally acquired seropositivity. There was no difference in the prevalence of coronary artery disease between patients with and without CMV infection or disease. We conclude that using the current passive immunization scheme the occurrence of CMV infection and disease is largely dependent on the serostatus of the donor.
我们分析了146例心脏移植受者中针对巨细胞病毒（CMV）的被动免疫结果。65例血清学阴性的受者在手术期间及术后接受了抗CMV免疫球蛋白的预防性治疗。这65例患者中有29例接受了血清学阳性供者的心脏。21/65血清学阴性受者及40/81血清学阳性受者发生了CMV感染（差异无统计学意义）。CMV匹配供者心脏的血清学阴性受者中CMV感染发生率（3/34）显著低于血清学阳性供者心脏的血清学阴性受者，且低于血清学阳性受者，但后两组之间的感染率无显著差异（18/29 vs. 40/81）。虽然原发性感染比继发性感染更常导致CMV疾病（11/21 vs. 10/40），但血清学阴性和血清学阳性患者之间的疾病发生率无差异（11/65 vs. 10/81），原发性或继发性感染后症状的严重程度也无差异。接受血清学阳性供者心脏的所有患者中CMV疾病的发生率高于接受血清学阴性供者心脏的患者。然而，在接受血清学阳性供者心脏移植后，我们被动免疫的血清学阴性患者中观察到的CMV疾病发生率（27%）与自然获得血清学阳性的患者相同。有CMV感染或疾病的患者与无CMV感染或疾病的患者之间冠状动脉疾病的患病率无差异。我们得出结论，使用当前的被动免疫方案，CMV感染和疾病的发生在很大程度上取决于供者的血清学状态。
