PDF(Pubmed)
Abstract：
Cytomegalovirus (CMV) infections remain a common problem after solid-organ transplantation. We characterized the burden of CMV infections, and adverse events of CMV prophylaxis after simultaneous pancreas-kidney transplantation (SPK). We included all SPK patients (n = 236) since 2010 in our country. Immunosuppression was ATG, tacrolimus, mycophenolate, and steroids. Valganciclovir prophylaxis was given to all CMV D+/R- patients for six months, and to seropositive SPK patients for three months since February 2019. CMV DNAemia was monitored with quantitative PCR from plasma. Among D+/R- SPK recipients, post prophylaxis CMV infection was detected in 41/60 (68%) during follow-up. In seropositive SPK recipients with no prophylaxis, CMV infection was detected in 53/95 (56%), vs. 28/78 (36%) in those who received 3 months of prophylaxis (P = 0.01). CMV was symptomatic in 35 (15%) patients, of which 10 required hospitalization. Mean duration of viremia was 28 days (IQR 21-41). Leukopenia was detected in 63 (46%) of the 138 patients with valganciclovir prophylaxis. 7/122 (6%) of the CMV infections detected were defined as refractory to treatment, and three patients had confirmed ganciclovir resistance. SPK recipients experience a high burden of CMV infections despite CMV prophylaxis. Leukopenia is common during valganciclovir prophylaxis.
摘要：
巨细胞病毒（CMV）感染仍然是实体器官移植后的常见问题。我们描述了CMV感染的负担，胰肾联合移植（SPK）后CMV预防的不良事件。我们纳入了2010年以来我国所有SPK患者（n=236）。免疫抑制是ATG，他克莫司,霉酚酸酯,和类固醇。对所有CMVD+/R-患者给予伐更昔洛韦预防6个月，以及自2019年2月以来三个月的血清阳性SPK患者。用定量PCR从血浆中监测CMVDNA血症。在D+/R-SPK收件人中，预防后CMV感染在随访期间检测到41/60（68％）。在没有预防的血清阳性SPK接受者中，在53/95（56％）中检测到CMV感染，vs.28/78（36％）在接受3个月预防的人中（P=0.01）。35例（15%）患者出现CMV症状，其中10人需要住院治疗。病毒血症的平均持续时间为28天(IQR21-41)。在138例使用伐更昔洛韦预防的患者中，有63例（46％）检测到白细胞减少症。7/122（6％）的CMV感染检测被定义为难治性治疗，3例患者证实更昔洛韦耐药。尽管有CMV预防，SPK接受者的CMV感染负担仍然很高。在伐更昔洛韦预防期间白细胞减少症很常见。
