Cytomegalovirus in solid organ transplant recipients-Guidelines of the American Society of Transplantation Infectious Diseases Community of Practice
Cytomegalovirus in solid organ transplant recipients-Guidelines of the American Society of Transplantation Infectious Diseases Community of Practice
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DOI：
10.1111/ctr.13512
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发表时间：
2019-09-01
影响因子：
2.1
通讯作者：
Humar, Atul
中科院分区：
文献类型：
--
作者：
Razonable, Raymund R.;Humar, Atul
巨细胞病毒(CMV)是影响实体器官移植预后的最常见的机会性感染之一。美国移植传染病协会的这份最新指南为实体器官移植受者巨细胞病毒的筛查、诊断、预防和治疗提供了循证和专家建议。CMV血清学检测免疫球蛋白G仍然是移植前筛查捐赠者和移植候选者的标准方法。抗病毒预防和预防性治疗是预防CMV的主要手段。由于CMV核酸检测的变异性，即使在校准器标准化的当代，也突出了缺乏广泛适用的病毒载量诊断和预防性治疗阈值的问题。伐更昔洛韦和静脉注射更昔洛韦仍然是巨细胞病毒治疗的首选药物。提出了管理耐药巨细胞病毒感染的策略。越来越多地使用CMV特异性细胞介导的免疫分析方法来对实体器官移植后CMV感染的风险进行分层，但它们在优化CMV预防和治疗工作中的作用尚未得到证实。讨论了与儿科移植受者相关的具体问题。
Cytomegalovirus (CMV) is one of the most common opportunistic infections that affect the outcome of solid organ transplantation. This updated guideline from the American Society of Transplantation Infectious Diseases Community of Practice provides evidence-based and expert recommendations for screening, diagnosis, prevention, and treatment of CMV in solid organ transplant recipients. CMV serology to detect immunoglobulin G remains as the standard method for pretransplant screening of donors and transplant candidates. Antiviral prophylaxis and preemptive therapy are the mainstays of CMV prevention. The lack of a widely applicable viral load threshold for diagnosis and preemptive therapy is highlighted, as a result of variability of CMV nucleic acid testing, even in the contemporary era when calibrators are standardized. Valganciclovir and intravenous ganciclovir remain as drugs of choice for CMV management. Strategies for managing drug-resistant CMV infection are presented. There is an increasing use of CMV-specific cell-mediated immune assays to stratify the risk of CMV infection after solid organ transplantation, but their role in optimizing CMV prevention and treatment efforts has yet to be demonstrated. Specific issues related to pediatric transplant recipients are discussed.