Ginevri F, Losurdo G, Fontana I, Rabagliati A M, Bonatto L, Valente R, Venzano P, Nocera A, Basile G C, Valente U, Gusmano R
Department of Nephrology, G. Gaslini Institute, Genoa, Italy.
Transpl Int. 1998;11 Suppl 1:S130-4. doi: 10.1007/s001470050444.
Cytomegalovirus (CMV) infection is still a major cause of morbidity in high-risk renal transplant recipients. In the present report, we have reviewed our records of renal transplant pediatric recipients (RTPR; mean age 14.1 +/- 4.9 years) since 1991, when we started a policy of CMV prophylaxis constituting high-dose oral acyclovir plus CMV hyperimmune immunoglobulins (HIg) followed by early i.v. ganciclovir therapy in high-risk patients (i.e., CMV donor+/recipient-). Four patients received a kidney from a living relative (LR), 2 patients had one previous transplant, and 1 had a combined liver-kidney transplant. Thirty-three patients who were negative for CMV antibodies (ab) before transplantation received a kidney from CMV ab positive donors. The immunosuppressive regimen included cyclosporine A and steroids, with the addition of azathioprine in the 4 patients who received an LR kidney. Serial assessments for CMV antigenemia (pp 65) were routinely performed for 6 months after transplantation to define CMV infection. Among the 33 CMV seronegative recipients (R-) who received the graft from a CMV seropositive donor (D+), 18 (54.5%) experienced CMV infection, whereas among the 28 CMV R+, who received a graft from a CMV D+, 11 (39.3%) experienced CMV infection. With regard to CMV- related symptoms, only 2 patients suffered from a CMV syndrome (fever and leukopenia in 1 patient, fever and arthralgia in the other). In no case did the spectrum of CMV disease occur; only minor symptoms were present in 7 of the remaining CMV-infected patients (fever in 6 and leukopenia in 1). Rejection episodes and renal function did not differ between CMV-infected and non-CMV-infected patients. Our experiences support the use of prophylactic acyclovir plus CMV HIg followed by early therapy with i.v. ganciclovir to combat the risk of increased morbidity in high risk RTPR.
巨细胞病毒（CMV）感染仍是高危肾移植受者发病的主要原因。在本报告中，我们回顾了自1991年以来肾移植儿科受者（RTPR；平均年龄14.1±4.9岁）的记录，当时我们开始实施一项CMV预防策略，即大剂量口服阿昔洛韦加CMV高免疫球蛋白（HIg），随后对高危患者（即CMV供体+/受体-）进行早期静脉注射更昔洛韦治疗。4例患者接受了来自活体亲属（LR）的肾脏，2例患者曾接受过一次移植，1例患者接受了肝肾联合移植。33例移植前CMV抗体（ab）阴性的患者接受了来自CMV ab阳性供体的肾脏。免疫抑制方案包括环孢素A和类固醇，接受LR肾脏的4例患者还加用了硫唑嘌呤。移植后6个月常规进行CMV抗原血症（pp 65）的系列评估以确定CMV感染。在33例从CMV血清阳性供体（D+）接受移植的CMV血清阴性受者（R-）中，18例（54.5%）发生了CMV感染，而在28例从CMV D+接受移植的CMV R+受者中，11例（39.3%）发生了CMV感染。关于CMV相关症状，只有2例患者出现CMV综合征（1例患者发热和白细胞减少，另1例患者发热和关节痛）。未出现CMV疾病谱；其余7例CMV感染患者仅出现轻微症状（6例发热，1例白细胞减少）。CMV感染患者和未感染CMV患者之间的排斥反应和肾功能无差异。我们的经验支持使用预防性阿昔洛韦加CMV HIg，随后早期静脉注射更昔洛韦治疗，以应对高危RTPR发病风险增加的问题。
