Cytomegalovirus prophylaxis in solid organ transplant recipients
Cytomegalovirus prophylaxis in solid organ transplant recipients
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DOI：
10.1097/00007890-199605150-00001
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发表时间：
1996-05-15
期刊：
影响因子：
6.2
通讯作者：
Paya, CV
中科院分区：
文献类型：
--
作者：
Patel, R;Snydman, DR;Paya, CV
在肾、肝、心脏和心肺移植受者中，症状性巨细胞病毒（CMV*）感染的发生率分别为8%、29%、25%和39%（1）。CMV主要通过供体器官传播给移植受者，较少程度上通过血液制品传播（2）。在实体器官移植受者中，CMV与以下因素有关：（1）感染性疾病综合征和器官受累（肺、肝、胃肠道、视网膜炎等）;（2）免疫抑制增加（因此，它经常与其他机会性感染，如真菌和肺孢子虫）（3）;和（3）尽管有争议，但急性和慢性同种异体移植物损伤（4，5）CMV感染的诊断是基于对组织中巨细胞包涵体的识别。此外，还使用管细胞和壳瓶培养技术来检测体液和组织中复制的CMV。血液（病毒血症）或组织活检中CMV的表现与临床活动性或即将发生的感染高度相关，而从尿液或呼吸道分泌物中分离出病毒通常是无症状感染的标志。直接检测移植受者血液白细胞中的抗原血症比壳瓶技术更敏感和快速，并提供了活动性CMV感染的早期标志物（6，7）。聚合酶链反应（PCR）技术可以检测外周血白细胞（8）、血清或血浆（9）和其他临床标本中的CMV DNA，以及外周血白细胞中的CMV RNA。目前正在评估PCR的临床实用性。
Symptomatic cytomegalovirus (CMV*) infection occurs in 8%, 29%, 25%, and 39% of kidney, liver, heart, and heartlung transplant recipients, respectively (1). CMV is transmitted to transplant recipients mainly by the donor organ and to a lesser degree by blood products (2). In the solid organ transplant recipient, CMV is related to:(1) infectious diseases syndromes and organ involvement (lung, liver, gastro-intestinal, retinitis, among others);(2) increased immunosuppression (hence its frequent association with other opportunistic infections, eg, fungal and Pneumocystis)(3); and (3) although controversial, acute and chronic allograft injury (4, 5).The diagnosis of CMV infection is based on the recognition of cytomegalic inclusion bodies in tissue. In addition, tube cell and shell vial culture techniques are used to detect replicating CMV in body fluids and in tissue. Demonstration of CMV in blood (viremia) or in tissue biopsies is highly correlated with the presence of clinically active or impending infection, whereas isolation of the virus from urine or respiratory secretions is frequently a marker of asymptomatic infection. Direct detection of antigenemia in blood leukocytes of transplant recipients is sensitive and more rapid than the shell vial technique, and provides an early marker of active CMV infection (6, 7). Polymerase chain reaction (PCR) techniques can detect CMV DNA in peripheral blood leukocytes (8), serum or plasma (9), and other clinical specimens, as well as CMV RNA in peripheral blood leukocytes. The clinical usefulness of PCR is currently being evaluated.