Ganciclovir/valganciclovir prophylaxis decreases cytomegalovirus-related events and bronchiolitis obliterans syndrome after lung transplantation
Ganciclovir/valganciclovir prophylaxis decreases cytomegalovirus-related events and bronchiolitis obliterans syndrome after lung transplantation
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DOI：
10.1086/528689
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发表时间：
2008-03-15
影响因子：
11.8
通讯作者：
Boehler, Annette
中科院分区：
文献类型：
--
作者：
Chmiel, Corinne;Speich, Rudolf;Boehler, Annette
背景资料。直到最近，巨细胞病毒(CMV)感染仍是肺移植受者的主要威胁。初步研究表明，抗病毒预防可能会改善这些患者的预后。我们延长了口服更昔洛韦(每天1克，3次)或伐更昔洛韦(450毫克，每天两次)延长预防时间的初步试点试验。这项试验包括96名有巨细胞病毒相关事件风险的患者。CMV预防导致CMV相关事件(即活动性感染和疾病)显著减少，从对照组的75%和未接受预防的文献中的274例患者的累积发生率降至27%(P<；.001)。接受预防性治疗的患者中只有11%患上了巨细胞病毒病(P<；.001)。此外，5年后，无论采用何种免疫抑制方案，闭塞性毛细支气管炎综合征的发生率显著下降，从60%下降到43%(P=0.002)，存活率从47%提高到73%(P=0.036)。在12例分析病例中有7例发现了UL97突变的CMV毒株，但该突变的存在对CMV疾病的严重程度没有影响。长期预防更昔洛韦或万乃昔洛韦可降低CMV活动性感染率和发病率，减少闭塞性毛细支气管炎综合征的发生率，提高存活率。可能会出现耐药的CMV毒株，但这些毒株似乎对CMV相关事件的结果没有影响。
Background. Until recently, cytomegalovirus (CMV) infection represented a major threat to lung transplant recipients. Preliminary studies have shown that antiviral prophylaxis might improve the outcome for these patients.Methods. We extended our initial pilot trial of prolonged prophylaxis with either oral ganciclovir (1 g 3 times per day) or valganciclovir (450 mg twice per day). The trial included 96 patients who were at risk for CMV-related events.Results. CMV prophylaxis resulted in a significant decrease in CMV-related events (i.e., active infection and disease), from 75% in a control group and for 274 cases from the literature who did not receive prophylaxis to a cumulative incidence of 27% (P < .001). Only 11% of the prophylaxis recipients experienced CMV disease (P < .001). Moreover, at 5 years, there was a significant decrease in the rate of bronchiolitis obliterans syndrome, from 60% to 43% (P = .002), and an improved rate of survival, from 47% to 73% (P = .036), irrespective of the immunosuppressive regimen received. CMV strains with UL97 mutations were recovered from 7 of 12 analyzed cases, but the presence of this mutation had no impact on the severity of CMV disease.Conclusions. A regimen of prolonged ganciclovir or valganciclovir prophylaxis decreased the rate of active CMV infection and disease, reduced the incidence of bronchiolitis obliterans syndrome, and improved the survival rate. Drug-resistant CMV strains may occur, but such strains appeared to have no impact on the outcome of CMV-related events.