Soghikian M V, Valentine V G, Berry G J, Patel H R, Robbins R C, Theodore J
Department of Medicine, Stanford University Medical Center, Calif, USA.
J Heart Lung Transplant. 1996 Sep;15(9):881-7.
Cytomegalovirus infection threatens pulmonary allograft survival and function. This retrospective study details the experience of ganciclovir prophylaxis against cytomegalovirus infection and its sequelae.
Eight-nine lung and heart-lung transplant recipients with positive cytomegalovirus serology were analyzed. The 37 recipients who underwent transplantation before September 1989 received no prophylaxis. The 52 subsequent recipients received ganciclovir prophylaxis.
Thirty-six non-prophylaxed versus 42 prophylaxed patients had cytomegalovirus events with cumulative incidences of 100% and 86% (p < < 0.01), and median onsets of 37 +/- 21 versus 85 +/- 35 days, respectively (p < < 0.01); 22 non-prophylaxed versus 27 prophylaxed patients had cytomegalovirus pneumonitis with cumulative incidences of 60% and 55% (p < < 0.01), and median onsets of 34 +/- 14 and 84 +/- 26 days, respectively (p < < 0.01). Respiratory failure caused by cytomegalovirus pneumonitis developed in nine of the non-prophylaxed versus two of the prophylaxed patients (p < < 0.01). The significant estimated survival benefit in patients who received prophylaxis (p = 0.04) was not apparent when reanalysis was performed after exclusion of patients with respiratory failure (p = 0.36). Ganciclovir prophylaxis produced a significant delay in the development of obliterative bronchiolitis with a median time to onset of 1072 +/- 280 days versus 432 +/- 189 days for the non-prophylaxis cohort (p < < 0.01).
Ganciclovir prophylaxis (1) improves recipient survival by reducing the severity of disease and essentially eliminating respiratory failure caused by cytomegalovirus pneumonitis, (2) reduces the incidence and delays the onset of cytomegalovirus events and pneumonitis, and (3) delays the onset of obliterative bronchiolitis.
巨细胞病毒感染威胁肺移植受者的移植物存活及功能。本回顾性研究详细阐述了更昔洛韦预防巨细胞病毒感染及其后遗症的经验。
对89例巨细胞病毒血清学阳性的肺及心肺移植受者进行分析。1989年9月之前接受移植的37例受者未接受预防治疗。随后的52例受者接受了更昔洛韦预防治疗。
36例未接受预防治疗的患者与42例接受预防治疗的患者发生了巨细胞病毒相关事件，累积发生率分别为100%和86%（p << 0.01），中位发病时间分别为37±21天和85±35天（p << 0.01）；22例未接受预防治疗的患者与27例接受预防治疗的患者发生了巨细胞病毒性肺炎，累积发生率分别为60%和55%（p << 0.01），中位发病时间分别为34±14天和84±26天（p << 0.01）。未接受预防治疗的患者中有9例因巨细胞病毒性肺炎导致呼吸衰竭，而接受预防治疗的患者中有2例（p << 0.01）。在排除呼吸衰竭患者后重新分析时，接受预防治疗患者显著的生存获益（p = 0.04）并不明显（p = 0.36）。更昔洛韦预防治疗显著延迟了闭塞性细支气管炎的发生，中位发病时间为1072±280天，而未接受预防治疗组为432±189天（p << 0.01）。
更昔洛韦预防治疗（1）通过减轻疾病严重程度并基本消除由巨细胞病毒性肺炎引起的呼吸衰竭来提高受者生存率，（2）降低巨细胞病毒相关事件和肺炎的发生率并延迟其发病，（3）延迟闭塞性细支气管炎的发病。
