Wiesner R H, Marin E, Porayko M K, Steers J L, Krom R A, Paya C V
Liver Transplantation Unit, Mayo Clinic, Rochester, Minnesota.
Gastroenterol Clin North Am. 1993 Jun;22(2):351-66.
CMV is one of the most frequent viral infections after orthotopic liver transplantation. Thus, there should be a high index of clinical suspicion, particularly in liver transplant recipients who have risk factors for the development of CMV disease, including donor CMV seropositivity, the use of antilymphocyte preparations, and retransplantation. The availability of effective antiviral therapy to treat CMV disease has emphasized the importance of an aggressive approach to the early diagnosis and treatment of this viral infection. Ganciclovir has been a major advancement in the treatment of severe CMV disease and has had a major impact on reducing the incidence and severity of CMV disease and its complications in the liver transplant recipient. Furthermore, these antiviral agents are now being evaluated for their prophylactic potential. Indeed, a number of these agents or combinations of these agents have been shown to be effective in reducing the incidence and severity of CMV disease, particularly in the CMV-seropositive transplant recipient; however, the cost-effectiveness of such therapy and its overall impact on long-term graft and patient outcome remain poorly defined at this time. Further investigations will be needed to define the role and importance of prophylactic therapy for the prevention of CMV infection and disease in the liver transplant recipient.
巨细胞病毒（CMV）是原位肝移植后最常见的病毒感染之一。因此，临床怀疑指数应较高，尤其是在有CMV疾病发生风险因素的肝移植受者中，这些因素包括供体CMV血清学阳性、使用抗淋巴细胞制剂以及再次移植。有效抗病毒疗法治疗CMV疾病的可用性凸显了积极早期诊断和治疗这种病毒感染的重要性。更昔洛韦是治疗严重CMV疾病的一项重大进展，对降低肝移植受者中CMV疾病及其并发症的发生率和严重程度产生了重大影响。此外，目前正在评估这些抗病毒药物的预防潜力。事实上，已证明许多此类药物或这些药物的组合在降低CMV疾病的发生率和严重程度方面有效，尤其是在CMV血清学阳性的移植受者中；然而，目前此类疗法的成本效益及其对长期移植物和患者预后的总体影响仍不明确。需要进一步研究来确定预防性治疗在预防肝移植受者CMV感染和疾病中的作用和重要性。
