急性排斥反应和移植物血管疾病减少抑制亚临床感染巨细胞病毒。
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Potena L, Holweg CT,下巴C, Luikart H, Weisshaar D,纳史木汗B, Fearon WF,刘易斯DB,库克JP, Mocarski, Valantine公顷
急性排斥反应和移植物血管疾病减少抑制亚临床感染巨细胞病毒。
移植。2006年8月15日,82 (3):398 - 405。
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16906040 (在PubMed]
- 文摘
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背景:Anticytomegalovirus (CMV)预防措施防止急性疾病,但它对亚临床感染和同种异体移植物的影响结果是未知的。我们试图确定巨细胞病毒预防心脏移植后三个月服用会改善病人的结果。方法:前瞻性队列研究的66年心脏移植受者比较激进的巨细胞病毒预防(n = 21,巨细胞病毒超免疫球蛋白静脉注射更昔洛韦(CMVIG) + 4周之后两个月的缬);与标准预防(n = 45,静脉注射更昔洛韦4周)。预防是基于移植前捐赠(D)和接受者(R)巨细胞病毒血清学:R - / D +收到积极的预防;R +收到标准预防。结果措施:巨细胞病毒感染评估外周血多形核白细胞dna聚合酶连锁反应,急性排斥反应和移植物血管疾病(CAV)通过血管内超声评估。所有患者完成一年的随访。结果。:巨细胞病毒感染是亚临床4例(每组两个)。 Aggressively treated patients had a lower incidence of CMV infection (73 +/- 10% vs. 94 +/- 4%; P = 0.038), and an independent reduced relative risk for acute rejection graded > or =3A (relative risk [95% CI] = 0.55 [0.26-0.96]; P = 0.03), as compared with the standard prophylaxis group. Aggressively prophylaxed patients also showed a slower progression of CAV, in terms of coronary artery lumen loss (lumen volume change=-21 +/- 13% vs. -10+/-14%; P = 0.05); and vessel shrinkage (vessel volume change = -15 +/- 11% vs. -3 +/- 18%; P = 0.03). CONCLUSIONS: Prolonged (val)ganciclovir plus CMVIG reduces viral levels, acute rejection, and allograft vascular disease, suggesting a role for chronic subclinical infection in the pathophysiology of the most common diseases affecting heart transplant recipients.