Bailey T C, Ettinger N A, Storch G A, Trulock E P, Hanto D W, Dunagan W C, Jendrisak M D, McCullough C S, Kenzora J L, Powderly W G
Department of Internal Medicine, Washington University School of Medicine, Saint Louis, Missouri.
Am J Med. 1993 Sep;95(3):273-8. doi: 10.1016/0002-9343(93)90279-x.
To assess the efficacy of acyclovir and intravenous immune globulin (IVIG) for cytomegalovirus (CMV) prophylaxis in high-risk recipients of solid organ transplants.
We randomized 21 CMV-seronegative organ transplant recipients with seropositive donors (D+R-) to receive oral acyclovir, 800 mg four times daily, or, in addition to acyclovir, IVIG, 300 mg/kg, every 2 weeks for six doses. Patients were followed closely for the development of CMV infection and disease.
All but one prophylactically treated patient (95%) developed CMV infection. Fifteen of 21 patients (71%) who received prophylaxis fulfilled criteria for CMV disease. Disease onset was delayed in those who received IVIG, but this did not reach statistical significance. Ganciclovir was used for treatment in 15 of the 21 patients (71%).
Acyclovir, with or without IVIG, did not prevent primary CMV infection or disease in D+R- solid organ transplant recipients at our institution. Moreover, most patients were treated with ganciclovir despite the use of prophylaxis. Given the ready availability of ganciclovir to treat CMV disease, we recommend a reappraisal of the role of CMV prophylaxis by these means in the solid organ transplant population.
评估阿昔洛韦和静脉注射免疫球蛋白（IVIG）对实体器官移植高危受者巨细胞病毒（CMV）预防的疗效。
我们将21名供体血清学阳性（D+）而受者血清学阴性（R-）的CMV血清学阴性器官移植受者随机分组，分别接受口服阿昔洛韦（每日4次，每次800mg），或除阿昔洛韦外，每2周接受一次IVIG（300mg/kg），共6剂。密切随访患者CMV感染和疾病的发生情况。
除1名预防性治疗的患者外，所有患者（95%）均发生了CMV感染。接受预防治疗的21名患者中有15名（71%）符合CMV疾病标准。接受IVIG的患者疾病发作有所延迟，但未达到统计学显著性。21名患者中有15名（71%）使用更昔洛韦进行治疗。
在我们机构，阿昔洛韦无论是否联合IVIG，均不能预防D+R-实体器官移植受者的原发性CMV感染或疾病。此外，尽管进行了预防治疗，大多数患者仍接受了更昔洛韦治疗。鉴于更昔洛韦可随时用于治疗CMV疾病，我们建议重新评估通过这些方法对实体器官移植人群进行CMV预防的作用。
