Use of cytomegalovirus immune globulin to prevent cytomegalovirus disease in renal-transplant recipients.
Use of cytomegalovirus immune globulin to prevent cytomegalovirus disease in renal-transplant recipients.
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使用巨细胞病毒免疫球蛋白预防肾移植受者的巨细胞病毒病。
DOI：
10.1056/nejm198710223171703
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发表时间：
1987
期刊：
影响因子：
--
通讯作者：
Levey,AS
中科院分区：
文献类型：
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作者：
Snydman,DR;Werner,BG;Heinze-Lacey,B;Berardi,VP;Tilney,NL;Kirkman,RL;Milford,EL;Cho,SI;BushJr,HL;Levey,AS
我们进行了一项前瞻性随机试验，以检查静脉注射巨细胞病毒（CMV）免疫球蛋白是否可以预防肾移植受者的原发性CMV疾病。59名CMV血清阴性患者接受了来自有CMV抗体供体的肾脏，被分配接受静脉注射CMV免疫球蛋白或不接受治疗。在移植后的前四个月内多次给予免疫球蛋白，CMV相关综合征的发生率从对照组的60%降低到接受CMV免疫球蛋白的21%（P<0.01）。真菌或寄生虫重叠感染在球蛋白受体中未见，但发生在20%的对照组中（P = 0.05）。只有4%的球蛋白接受者有明显的白细胞减少（反映严重的CMV疾病），而对照组有37%（P<0.01）。CMV肺炎的发生率也随之降低，但无统计学意义（对照组为17%，而球蛋白接受者为4%）。即使根据移植排斥治疗对患者进行分层，也观察到严重CMV相关疾病的显著减少（P = 0.04）。我们没有观察到免疫球蛋白对病毒分离率或血清转化率的影响，这表明治疗的患者往往窝藏病毒，但临床上明显的疾病是不太可能在them.We的结论是，巨细胞病毒免疫球蛋白提供了有效的预防肾移植受者在原发性巨细胞病毒疾病的风险。（N Engl J Med 1987; 317：1049-54.）
We undertook a prospective randomized trial to examine whether an intravenous cytomegalovirus (CMV) immune globulin would prevent primary CMV disease in renal-transplant recipients. Fifty-nine CMV-seronegative patients who received kidneys from donors who had antibodies against CMV were assigned to receive either intravenous CMV immune globulin or no treatment. The immune globulin was administered in multiple doses over the first four months after transplantation.The incidence of virologically confirmed CMV-associated syndromes was reduced from 60 percent in controls to 21 percent in recipients of CMV immune globulin (P<0.01). Fungal or parasitic superinfections were not seen in globulin recipients but occurred in 20 percent of controls (P = 0.05). Only 4 percent of globulin recipients had marked leukopenia (reflecting serious CMV disease), as compared with 37 percent of the controls (P<0.01). There was a concomitant but not statistically significant reduction in the incidence of CMV pneumonia (17 percent of controls as compared with 4 percent of globulin recipients). A significant reduction in serious CMV-associated disease was observed even when patients were stratified according to therapy for transplant rejection (P = 0.04). We observed no effect of immune globulin on rates of viral isolation or seroconversion, suggesting that treated patients often harbored the virus but that clinically evident disease was much less likely to develop in them.We conclude that CMV immune globulin provides effective prophylaxis in renal-transplant recipients at risk for primary CMV disease. (N Engl J Med 1987; 317: 1049–54.)