Effects of oral valganciclovir prophylaxis for cytomegalovirus infection in heart transplant patients
Effects of oral valganciclovir prophylaxis for cytomegalovirus infection in heart transplant patients
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DOI：
10.2147/dddt.s36578
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发表时间：
2012-10-11
影响因子：
4.8
通讯作者：
Katus, Hugo A.
中科院分区：
文献类型：
--
作者：
Doesch, Andreas O.;Repp, Janika;Katus, Hugo A.
背景：巨细胞病毒（CMV）感染是心脏移植术后的严重并发症。本研究（2003年6月- 2010年1月）回顾性评估了成年心脏移植受者在移植后第一年口服缬更昔洛韦预防的效果。方法：肾功能正常的患者在心脏移植术后14天内口服缬更昔洛韦900 mg，每日2次，连续6个月口服900 mg。在肾功能不全的情况下，根据制造商的建议调整缬更昔洛韦。抗原血症检测pp65抗原和同步聚合酶链反应（PCR）用于记录CMV暴露。从2003年到2010年，146例患者（74.0%为男性）在心脏移植时平均年龄为50.7±10.3岁。结果：16例患者（11.0%，男性75.0%）在心脏移植术后1年内pp65和PCR阳性（即巨细胞病毒感染）；其中3名患者在移植后的前6个月内因为白细胞减少而停止了缬更昔洛韦预防治疗，包括1名患者发生巨细胞病毒结肠炎。另外两名患者在预防性缬更昔洛韦治疗期间发生巨细胞病毒肺炎。8例患者在心脏移植后停止常规预防后的6-12个月内pp65和PCR检测呈阳性。其中一名患者发展为巨细胞病毒肺炎，另一名发展为巨细胞病毒结肠炎和巨细胞病毒肺炎。146例患者中有37例（25.3%）CMV供体血清阳性/受体血清阴性，7例（18.9%）CMV检测阳性。在巨细胞病毒供体-血清阳性/受体-血清阴性的患者中，巨细胞病毒检测阳性（即巨细胞病毒感染）的风险显著升高（P = 0.023）。结论：心脏移植术后口服缬更昔洛韦6个月预防巨细胞病毒在临床上是可行的。与先前的研究一致，巨细胞病毒供体-血清阳性/受体-血清阴性患者的巨细胞病毒感染风险显著升高。在过早停用缬更昔洛韦的患者中，密切监测巨细胞病毒抗原血症似乎是必要的。缬更昔洛韦预防治疗6个月后，CMV感染率未见明显升高。
Background: Cytomegalovirus (CMV) infection is a serious complication following heart transplantation. This study (June 2003-January 2010) retrospectively assessed the effects of oral valganciclovir prophylaxis in adult heart transplant recipients during the first year after transplantation.Methods: In patients with normal renal function, 900 mg of oral valganciclovir was administered twice daily for 14 days after heart transplant followed by 900 mg per day for following 6 months. In the event of renal insufficiency, valganciclovir was adjusted according to the manufacturer's recommendations. Antigenemia testing for pp65 antigen and simultaneous polymerase chain reaction (PCR) were used to document exposure to CMV. From 2003 to 2010, 146 patients (74.0% men) of mean age 50.7 +/- 10.3 years at the time of heart transplant were included.Results: A total of 16 patients (11.0% of total, 75.0% male) had a positive pp65 and PCR result (ie, CMV infection) during the year following heart transplant; three of these patients had discontinued valganciclovir prophylaxis within the first 6 months following transplant because of leukopenia, including one patient developed CMV colitis. Two further patients developed CMV pneumonia during prophylactic valganciclovir therapy. Eight patients had positive pp65 and PCR tests in the 6-12 months after heart transplant following cessation of routine prophylaxis. One of these patients developed CMV pneumonia and another developed CMV colitis and CMV pneumonia. Thirty-seven of the 146 (25.3%) patients were CMV donor-seropositive/recipient-seronegative, and seven (18.9% of this subgroup) had a positive CMV test. In patients who were CMV donor-seropositive/recipient-seronegative, the risk of a positive CMV test (ie, CMV infection) was significantly elevated (P = 0.023).Conclusion: CMV prophylaxis with oral valganciclovir for 6 months following heart transplant is clinically feasible. In line with previous studies, CMV donor-seropositive/recipient-seronegative patients have a significantly elevated risk of CMV infection. In patients who prematurely discontinue valganciclovir, close monitoring of CMV antigenemia appears warranted. No significantly elevated rate of CMV infection was observed after 6 months of valganciclovir prophylaxis.