Human Cytomegalovirus and Kidney Transplantation: A Clinician's Update
Human Cytomegalovirus and Kidney Transplantation: A Clinician's Update
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DOI：
10.1053/j.ajkd.2011.04.010
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发表时间：
2011-07-01
影响因子：
13.2
通讯作者：
Vanholder, Raymond
中科院分区：
文献类型：
--
作者：
De Keyzer, Kristel;Van Laecke, Steven;Vanholder, Raymond
人巨细胞病毒（CMV）感染是肾移植受者发病和死亡的重要原因。CMV疾病的诊断基于通过磷蛋白65抗原血症或CMV DNA聚合酶链反应检测病毒复制结合典型体征和症状。风险因素包括接受CMV血清阳性移植的CMV血清阴性受者、年龄较大的供体、暴露于环孢素和/或抗淋巴细胞抗体、排斥反应发作和移植功能受损。目前肾移植受者的预防策略包括用缬更昔洛韦或静脉注射更昔洛韦进行预防性治疗，以及在肾移植后3-6个月和用抗淋巴细胞抗体治疗后1-3个月用伐昔洛韦、缬更昔洛韦或更昔洛韦进行普遍预防。已确诊的疾病应使用静脉注射更昔洛韦或口服缬更昔洛韦治疗，直到不再检测到CMV复制。除了直接影响外，CMV感染还引起广泛的间接影响，例如移植和受体存活率降低以及对排斥反应和机会性感染的易感性。在这篇综述中，我们根据目前的证据和指南强调了CMV和肾移植最相关的主题。美国肾脏病杂志58（1）：118-126。(C)2011年，美国国家肾脏基金会（National Kidney Foundation，Inc.）
Infection with human cytomegalovirus (CMV) is an important cause of morbidity and mortality in kidney transplant recipients. CMV disease is diagnosed based on the detection of viral replication by phosphoprotein 65 antigenemia or CMV DNA polymerase chain reaction in combination with typical signs and symptoms. Risk factors include CMV-seronegative recipients receiving a CMV-seropositive transplant, older donor age, exposure to cyclosporine and/or antilymphocyte antibody, rejection episodes, and impaired transplant function. Current preventive strategies in kidney transplant recipients include pre-emptive therapy with valganciclovir or intravenous ganciclovir and universal prophylaxis with valacyclovir, valganciclovir, or ganciclovir for 3-6 months after kidney transplantation and for 1-3 months after treatment with antilymphocyte antibody. Established disease should be treated using either intravenous ganciclovir or oral valganciclovir until CMV replication can no longer be detected. In addition to direct effects, CMV infection also induces a wide range of indirect effects, such as decreased transplant and recipient survival and susceptibility to rejection and opportunistic infections. In this review, we highlight the most relevant topics on CMV and kidney transplantation based on current evidence and guidelines. Am J Kidney Dis. 58(1):118-126. (C) 2011 by the National Kidney Foundation, Inc.