巨细胞病毒pp65抗原血症检测

目的：评估巨细胞病毒（CMV）pp65白细胞抗原血症在骨髓移植或外周血干细胞移植后活动性CMV感染早期诊断和CMV 病的预测、指导CMV亚临床期感染的抗病毒治疗及抗病毒疗效判断中的价值。方法：1999年9月－2000年4月共收集 210份乙二胺四乙酸（EDTA）抗凝血，骨髓移植或外周血干细胞移植患者36例。移植前用ELISA法检测患者CMV特异性抗体IgG和IgM，移植后3周起采用CMV Brite试验盒每周检测1次CMV pp65抗原血症，并计数抗原 阳性细胞，直到移植后100d或治疗后抗原阴转、死亡或出院。移植后患者第1次检测到bp65抗原阳性细胞即开始更昔洛韦抗病毒治疗。结果：36例骨髓移植或干细胞移植患者于移植前CMV特异性抗体IgG均阳性，IgM均阴性；移植后16例出现CMV pp65抗原血症，其中15例 出现有症状的CMV感染或CMV病，14例接受更昔洛韦抗病毒治疗，12例治疗后抗原血症阴转、症状消失、死亡2例（病死率14．2％），未经抗病毒治疗者2例均死亡（P＜0．01）。16例pp65抗原阳性患者中，仅2例CMV特异性抗体IgM阳性。10名健康对照组的CMV特异性抗体IgG均阳性，IgM均阴性；pp65抗原血症 检测均阴性。结论：本研究结果提示，人CMV pp65白细胞抗原血症检测可作为骨髓移植后CMV病的预测指标，指导移植后抗病毒治疗的开展和疗效评价。pp65白细胞抗原症出现即开始抗病毒治疗可明显降低病死率。     

更昔洛韦胶囊在造血干细胞移植患者巨细胞病毒血症中的应用

目的 探讨更昔洛韦(ganciclovir,DHPG)胶囊治疗造血干细胞移植(HSCT)后患者巨细胞病毒(CMV)血症的疗效和安全性.方法 选择2006年2月至5月在北京大学血液病研究所行HSCT的30例移植后CMV血症患者进行前瞻性研究.CMV感染预防采用更昔洛韦10 mg/(kg·d),分2次静脉滴注,移植前第9天至移植前第2天,连续8 d.移植后应用定量多聚酶链反应(PCR)定期进行病毒DNA检测,CMV-DNA定量＞6.0×102拷贝/mL或＜1×105拷贝/mL的患者应用更昔洛韦胶囊1 g每日3次治疗.结果 HSCT后发生CMV血症的中位时间为移植后42 d,诊断时CMV-DNA中位数4.626×103拷贝/mL.更昔洛韦胶囊治疗的总有效率为90%,14 d转阴率66.67%,转阴中位时间10 d.4例(13.3%)出现不良事件,程度为轻至中度,表现为血细胞计数减少3例,转氨酶升高1例.结论 更昔洛韦胶囊用于治疗HSCT后CMV血症患者安全有效.     

异基因造血干细胞移植后巨细胞病毒感染的预先治疗

目的:探讨预防治疗及预先治疗对异基因造血干细胞移植后CMV感染的干预作用.方法:225例异基因造血干细胞移植患者中160例接受预先治疗,65例接受预防治疗,用logistic回归模型分析影响CMV感染的危险因素.结果:预先治疗组与预防治疗组比较,CMVpp65抗原血症、CMV病和CMV病死亡率分别为28.1%(35.3%,P>0.05),1.9%(12.3%,P<0.05)和0.6%(10.7%,P<0.01).单倍体相合移植组出现CM-Vpp65血症33.0%(40.0%,P>0.05)、CMV病发生率1.9%(12.0%,P<0.05)、死亡率0.0%(10.0%,P<0.05),均低于相合移植.单倍体相合移植组中CMVpp65阳性发生的主要危险因素为重症GVHD、移植前给予抗CMV治疗以及是否混合其他严重感染.结论:异基因移植后预先治疗优于预防治疗,可以明显减低CMV病的发生和死亡.     

更昔洛韦和膦甲酸钠预防异基因造血干细胞移植后巨细胞病毒感染效果比较的单中心、前瞻性随机对照研究

目的:比较膦甲酸钠和更昔洛韦预防用药对异基因造血干细胞移植(allo-HSCT)后巨细胞病毒(CMV)感染的疗效及安全性,为有效预防allo-HSCT后CMV感染提供临床参考。方法:前瞻性随机选取行allo-HSCT的69例患者,随机分为膦甲酸钠组60 mg/(kg·d)和更昔洛韦组5 mg/(kg·d),对2组患者用药期间和移植+100 d CMV感染及毒副作用进行临床观察,比较2种药物在allo-HSCT后CMV感染预防中的效果和安全性。结果:预防用药期间、移植+100 d CMV感染和CMV病发生率,更昔洛韦组分别是2.9%、20.6%、0,而膦甲酸钠组分别为11.4%、31.4%、11.4%;2组上述指标差异均无统计学意义(P0.05);但膦甲酸钠预防组CMV感染出现时间明显先于更昔洛韦预防组(P=0.015);毒副作用方面:2组用药期间,Ⅲ度粒细胞减少的发生,更昔洛韦组明显高于膦甲酸钠组(P=0.016);Ⅳ度粒细胞减少在2组间差异无统计学意义;2组在Ⅰ、Ⅱ度血小板减少的发生率上差异也无统计学意义;2组肾功能损害发生率相似,但电解质紊乱发生率在膦甲酸钠预防组较更昔洛韦预防组更常见(P=0.024)。用药预防期间,因不良反应停药的膦甲酸钠组有4例,更昔洛韦预防组未发生。结论:膦甲酸钠和更昔洛韦在预防allo-HSCT后CMV感染上疗效相当,但2组的不良反应有一定差异,因此预防使用膦甲酸钠或更昔洛韦应当个体化。     

异基因造血干细胞移植中巨细胞病毒潜伏感染的防治

目的:观察依据异基因造血干细胞移植前受者巨细胞病毒(CMV)血清学检测结果采取不同的CMV感染防治方案的临床效果。方法:行异基因造血干细胞移植的37例患者,移植预处理前1周依据受者CMV血清学检测结果,对于移植前PP65抗原、CMV抗体及CMV-DNA定量均阴性的受者,应用阿昔洛韦预防CMV感染;移植前PP65、IgM抗体及DNA定量阴性,IgG抗体阳性的受者应用静脉更昔洛韦预防CMV感染。预处理中及移植后均采用阿昔洛韦进行病毒感染的预防,并定期检测PP65及CMV-IgM和CMV-DNA定量,当出现PP65阳性和/或CMV-IgM阳性、病毒复制增加时,给予更昔洛韦或膦甲酸钠联合人免疫球蛋白治疗。结果:36例受者移植后检测CMV抗体IgG均为阳性,巨细胞病毒血症占18.9%(7/37),CMV病占10.8%(4/37),CMV感染的时间为移植后+27～+65d,CMV感染多见于非血缘、HLA不全相合及发生aGVHD的患者,经更昔洛韦和或膦甲酸钠治疗后无一例因CMV病死亡。应用不同预防CMV感染方法的患者间造血重建时间无明显差异。结论:依据受移植前受者血清学检测结果给予不同的预防方案并结合预先治疗方案防治CMV感染可以明显减少CMV潜伏感染转变为CMV病的概率,且对造血重建无影响。     

成人异体血液及骨髓移植受者患巨细胞病毒性(CMV)肺炎的研究

巨细胞病毒(CMV)性肺炎是异体血液及骨髓移植受者致病及致死的主要原因。为评估在移植后一年内更昔洛韦(ganciclovior)对CMV性肺炎发病频度,时间及结果有无作用,我们对541例血液及骨髓移植患者进行回顾性研究。在移植当天至移植后100天,口服更昔洛韦每周5次。结果:541人中,34人(6.5％)共发     

肾移植术后巨细胞病毒病的预防--CMV抗原检测指导的预防性抗病毒治疗

目的 :探讨肾移植术后巨细胞病毒 (CMV)病的预防。　 方法 :采用免疫组化法检测外周血白细胞CMV PP65抗原 ,术后头 3个月每周检查 1次 ,初次检测CMV PP65抗原阳性者 ,2 4h内给予丙氧鸟苷 2 5～ 5mg/(kg·d)静滴 ,疗程至少 4周或至CMV PP65抗原阴转后续用 7～ 14天 ;无效或出现丙氧鸟苷毒副作用时改用磷甲酸钠。　结果 :10 0例受者术后头 3个月检出CMV PP65抗原阳性 4 2例 ,5 8例抗原阴性的受者仅 1例发生CMV病。 4 2例CMV PP65抗原阳性受者丙氧鸟苷治疗后 3 6例 ( 85 7% )抗原阴转 ,6例经磷甲酸钠治疗抗原也阴转 ,平均阴转时间为 2 4 6± 11 3天 ,平均疗程为 3 4 2± 7 1天 ;仅 1例发展为CMV病。与没有给予预防性抗病毒治疗的对照组受者相比 ,CMV病的发病率和死亡率 (P <0 0 1)明显降低。　 结论 :CMV PP65抗原检测可用于指导肾移植受者CMV感染的预防性治疗 ;预防性抗病毒治疗可有效降低CMV抗原阳性者CMV病的发病率和死亡率     

异基因造血干细胞移植后巨细胞病毒肠炎的临床分析

目的：分析异基因造血干细胞移植后巨细胞病毒（CMV）肠炎的诊断及治疗情况并作文献复习,方法：6例中男5例,女1例,慢性髓细胞白血病5例,急性淋巴细胞白血病1例,非血缘HLA相合的骨髓移植（allo-BMT)1例,非血缘HLA不相合的allo-BMT 1例,HLA相合的同胞供髓的allo-BMT3例,HLA相合的同胞供干细胞的外周造血干细胞移植（allo-PBSCT)1例,结果：6例中5例分别于移植后42,26,66,45,57d发生Ⅱ-Ⅲ级急性移植物抗宿主病（aGVHD),经免疫抑制剂治疗好转,但于移植后50,57,80,138及65d出现腹痛腹泻加重及（或）消化道出血,1例无明显GVHD,但于移植后35d出现腹痛腹泻及消化道出血。6例中5例于症状出现后即行纤维结肠镜检查,见回肠和（或）结肠黏膜水肿,溃疡,活检发现炎性病变,巨细胞和（或）核内及胞浆病毒包涵体,免疫组化染色部分黏膜上皮,血管内皮对CMV抗体阳性,确诊为CMV肠炎;1例结合症状,血CMV－IgM阳性及对抗CMV治疗有效。结合临床诊断为CMV肠炎,经联用更昔洛韦,磷甲酸钠,大蒜素和静脉滴注免疫丙种球蛋白治疗,6例患者CMV肠炎均已治愈。结论：结肠镜及病理检查对CMJV肠炎的诊断具决定作用,早期诊断和治疗是成功的关键。     

长疗程口服更昔洛韦预防肾移植术后巨细胞病毒病

目的:探讨长疗程口服更昔洛韦预防肾移植术后巨细胞病毒(CMV)病的有效性及安全性。方法:2004年1月至2007年1月在本院进行首次肾移植的57例患者,分为预防组和对照组。预防组27例,术后即予更昔洛韦口服,每次1g,3次/d,维持用药3个月;对照组30例,不服用任何抗病毒药物。结果:长疗程预防性口服更昔洛韦能降低CMV病发病率(14.8%比20.0%),但未达到统计学差异(P>0.05);能明显推迟CMV病发病时间[(77.3±11.1)d比(63.2±14.1)d,P<0.05];降低CMV病发病时的严重程度,缩短病程[(11.5±2.2)d比(13.0±1.0)d,P0.05);预防组中2例发生不良反应。结论:长疗程口服更昔洛韦对CMV病的发病率无显著影响,但可降低CMV病的病死率,缩短病程。口服更昔洛韦的不良反应少。     

杀伤细胞免疫球蛋白样受体基因多态性对造血干细胞移植后巨细胞病毒感染的影响

  目的 探讨杀伤细胞免疫球蛋白样受体（KIR）基因的多态性对造血干细胞移植后巨细胞病毒（CMV）感染的影响。方法 选择2005年10月至2011年5月行造血干细胞移植供受体138对,移植前采用序列特异性引物聚合酶链反应（PCR-SSP）对供受体KIR基因分型,移植后2周起,每周采用荧光免疫组化法检测移植后患者外周血CMVpp65抗原,分析在CMV阳性组和CMV阴性组,供受体抑制性和激活性KIR基因以及供受体KIR单体型频率的差异。结果 供受体KIR基因频率分布和供受体AA,AB,BB单体型频率分布差异无统计学意义。供体2DS2、2DS4*003-007基因在CMV阳性组频率明显低于CMV阴性组（8%比16%,P=0.0420;3%比13%,P=0.0050）,受体KIR基因在CMV阳性组和阴性组频率的差异无统计学意义。供体BB单体型CMV感染率明显低于AA单体型（36.84%比64.38%,P=0.0299）,受体各单体型间CMV感染率差异无统计学意义。多因素分析发现2DS4*003-007,BB单体型与CMV感染有关。结论 供体KIR 基因多态性与造血干细胞移植后CMV感染相关。        

Ultrastructural changes in peripheral blood neutrophils in a patient receiving ganciclovir for CMV pneumonitis following allogenic bone marrow transplantation.

A 13-year-old splenectomized, multitransfused beta-thalassemia major, male patient received an allogenic BMT from his HLA-compatible brother after suffering grade III regimen-related pulmonary toxicity. He developed features of CMV pneumonitis with positive pp65 CMV antigenemia involving 2.5% peripheral blood neutrophils from day +46. The patient received intravenous immunoglobulin and ganciclovir 5 mg/kg intravenously twice daily. His neutrophil count was maintained above 1 x 10(9)/l by G-CSF 5 microg/kg subcutaneously as and when required. From day 7 onwards following twice daily ganciclovir his peripheral blood smear started showing isolated cytoplasmic inclusions, 1-3 per neutrophil, 3-5 mu in diameter, involving 2-3% of the neutrophils and occasional monocytes. Transmission election microscopy of peripheral blood neutrophils showed type I and type II intranuclear inclusions. These inclusions disappeared within 48 h of stopping ganciclovir. Inclusions were not seen in three patients who were given prophylactic ganciclovir 5 mg/kg once daily for 5 days every week following allogenic BMT after the same conditioning regimen. These patients were also negative for CMV antigenemia. Development of type I and type II intranuclear inclusions in blood neutrophils in patients receiving ganciclovir therapy has not been reported previously, and the striking light microscopic changes provide simple morphological evidence of the toxic effect of this drug on blood neutrophils.     

Randomized clinical trial of ganciclovir vs acyclovir for prevention of cytomegalovirus antigenemia after allogeneic transplantation

Cytomegalovirus (CMV) disease remains a major cause of morbidity following allogeneic stem cell transplantation (SCT). In a prospective randomized trial, we tested prophylactic therapy with ganciclovir or acyclovir for patients at high risk of disease. Ninety-one CMV seropositive recipients of related (n = 53) and unrelated (n = 38) donor transplants were enrolled. All patients received intravenous (i.v.) ganciclovir 5 mg/kg every 12 h days -7 to -2, followed by acyclovir 10 mg/kg i.v. every 8 h from day -1 until neutrophil engraftment. Patients were then randomly assigned to either ganciclovir (n = 45) or acyclovir (n = 46) until day 100 post transplant. Any degree of antigenemia was treated with ganciclovir 5 mg/kg i.v. twice a day for 2 weeks, followed by 5 mg/kg i.v. each weekday for 6 weeks. At day 100, the cumulative incidence of antigenemia was 31% (95% CI 17-45%) for ganciclovir and 41% (95% CI 26-56%) (P = 0.22) for acyclovir prophylaxis, respectively. The assigned prophylaxis cohort did not predict for CMV antigenemia. The cumulative incidence of CMV disease at 12 months was 13% (95% CI 3-23%) and 17% (95% CI 6-28%) (P = 0.59) for the ganciclovir- and acyclovir-treated groups, respectively. An absolute neutrophil count (ANC) 相似文献   

Rising pp65 antigenemia during preemptive anticytomegalovirus therapy after allogeneic hematopoietic stem cell transplantation: risk factors, correlation with DNA load, and outcomes

To determine the risk factors and outcomes associated with rising cytomegalovirus (CMV) antigenemia levels during preemptive therapy among stem cell allograft recipients, 119 patients with CMV antigenemia were studied. Patients were prospectively monitored for CMV antigenemia weekly; those with positive findings on antigenemia tests were treated with intravenous ganciclovir (5 mg/kg twice daily for 1 week, followed by 5 mg/kg per day for 5-6 d/wk). While on therapy, 47 of 119 (39%) patients demonstrated increases that were 2 or more times greater than their baseline values, whereas 33 of 119 (28%) patients demonstrated increases that were 5 or more times greater. Rising antigenemia was confirmed by polymerase chain reaction for CMV DNA. Multivariate analysis identified corticosteroids as the primary risk factor for increasing antigenemia: for increases greater than or equal to twice the baseline, 1 to 2 mg/kg steroids was associated with an odds ratio (OR) of 4.0. For increases greater than or equal to 2 mg/kg steroids, the OR was 10.1. CMV isolates obtained at the time of rising antigenemia were susceptible to ganciclovir, indicating that resistance was not a major factor. Overall, rising antigenemia levels were not correlated with CMV disease. All 4 patients in whom CMV disease developed during therapy, however, had rising antigenemia levels. Among the 47 patients with antigenemia increases greater than or equal to twice the baseline, 15 were re-induced with antivirals, whereas 32 continued to receive maintenance therapy. All 4 patients in whom CMV disease developed during therapy received maintenance therapy, and 3 died with CMV disease. Thus, host factors such as the receipt of corticosteroids explain increasing viral load during the early phase of preemptive therapy. Continued induction dosing or re-induction may protect against early breakthrough CMV disease and CMV-related death among patients with rising antigenemia on preemptive therapy. (Blood. 2001;97:867-874)     

A randomised trial comparing cytomegalovirus antigenemia assay vs screening bronchoscopy for the early detection and prevention of disease in allogeneic bone marrow and peripheral blood stem cell transplant recipients

Preemptive antiviral therapy is often employed for CMV prevention following allogeneic BMT. Two common strategies are a screening bronchoscopy for CMV post-BMT or regular CMV antigenemia testing with ganciclovir administration for a positive result. In a randomised trial, we prospectively compared the efficacy of these two preemptive strategies. Consecutive patients were randomised to either a bronchoscopy for CMV on day 35 post BMT or weekly CMV antigenemia testing. If the bronchoscopy was positive for CMV, patients received preemptive ganciclovir for 8-10 weeks. If the antigenemia was positive for CMV, patients received a minimum of 2 weeks of preemptive ganciclovir. The primary endpoint was the development of active CMV disease. One hundred and eighteen allogeneic BMT patients were enrolled (60 in the antigenemia arm and 58 in the bronchoscopy arm). The two groups were comparable with respect to baseline demographic data, underlying disease, conditioning regimen, and immunosuppression. Active CMV disease developed in 7/58 (12.1%) patients in the bronchoscopy arm vs 1/60 patients (1.7%) in the CMV antigenemia arm (P = 0.022). Based on the screening test, 13.8% of patients received preemptive ganciclovir in the bronchoscopy arm vs 48.3% of patients in the antigenemia arm (P < 0.001). There was no significant difference in the rate of graft-versus-host disease, bacteremia, invasive fungal infections or mortality between the two groups. Preemptive therapy based on regular CMV antigenemia monitoring is superior to screening bronchoscopy for the prevention of CMV disease after allogeneic BMT.     

High-dose acyclovir and pre-emptive ganciclovir in prevention of cytomegalovirus disease in pediatric patients following peripheral blood stem cell transplantation

Cytomegalovirus (CMV) disease remains an important cause of morbidity and mortality in patients undergoing hematopoietic stem cell transplantation (HSCT). We evaluated high-dose acyclovir (HDACV) and pre-emptive ganciclovir to prevent CMV disease in 76 children who underwent peripheral blood stem cell transplantation (PBSCT) and were at risk for CMV reactivation and disease (both recipient and donor seropositive) from May 1998 to April 2003. All received HDACV from day -9 to 6 months post transplant in conjunction with weekly CMV pp65 antigenemia monitoring. The incidence of antigenemia in this cohort was 19.7%, at a median of 22 days post-PBSCT. The frequencies were 26.4 and 4.4% in allogeneic and autologous groups, respectively (P=0.03). Patients with nonmalignant disease had higher CMV antigenemia than those with malignant disease (30.8 vs 8.1%, P=0.02). Age at PBSCT, sex, graft-versus-host disease (GVHD) prophylaxis regimen and presence of acute GVHD did not affect the risk of CMV antigenemia. None of the patients who had positive pp65 antigenemia developed CMV disease during the study period. We conclude that pp65 antigenemia-guided HDACV and pre-emptive ganciclovir may prevent CMV disease in children undergoing PBSCT.     

High-dose acyclovir and pre-emptive ganciclovir to prevent cytomegalovirus disease in myeloablative and non-myeloablative allogeneic stem cell transplantation

We evaluated high-dose acyclovir and pre-emptive ganciclovir to prevent cytomegalovirus disease in myeloablative and non-myeloablative allogeneic stem cell transplantation. One hundred and seventy-four consecutive patients who were at risk for CMV infection (either recipient or donor seropositive) and received either intensive chemoradiotherapy and a T cell-depleted stem cell transplant followed by delayed add-back of donor T cells (TCDT: n = 98), or a non-myeloablative preparative regimen followed by an unmanipulated peripheral blood stem cell transplant (NMT: n = 76) from an HLA-identical sibling donor were studied. All received high-dose acyclovir (HDACV) from day - 7 for 3 months post-transplant in conjunction with weekly CMV pp65 antigenemia monitoring and pre-emptive treatment with intravenous immunoglobulin (not CMV-specific) and ganciclovir. The actuarial probabilities of developing pp65 antigenemia were 83 +/- 4% after TCDT and 41 +/- 6% after NMT (P < 0.00001) with reactivation occurring earlier in the TCDT group (the median 36 days vs 55 days). We observed no reactivation of CMV in seronegative recipients with a seropositive donor (n = 23). A total of 11 patients (5 in TCDT, 6 in NMT) developed CMV disease within 400 days after transplantation, and one death was clearly attributable to CMV interstitial pneumonitis (IP). This strategy was associated with effective control of CMV antigenemia in the majority of patients and near-complete eradication of fatal CMV IP.     

Sequential cytomegalovirus antigenemia monitoring in kidney transplant patients treated with antilymphocyte antibodies

BACKGROUND: Antilymphocyte antibodies (ALA) use is related to disseminated cytomegalovirus (CMV) disease after kidney transplantation. Strict surveillance of CMV infection, preemptive antiviral treatment or concomitant ganciclovir and ALA use are proposed as an attempt to prevent related clinical complications. Our objective was to describe the pattern of CMV infection, based on sequential antigenemia detection, after ALA treatment. PATIENTS AND METHODS: Thirty renal transplant patients were prospectively screened for CMV infection after ALA treatment. CMV antigenemia (pp65 antigen detection) was monitored twice a week in the first month and weekly until 60 days after the beginning of ALA therapy. Any positive value of antigenemia was considered CMV infection. RESULTS: Twenty-eight (93.3%) patients were CMV positive (IgG) before transplantation. The mean duration of ALA treatment was 12.1+/-2.4 days. Positive antigenemia was detected in 24 (80%) patients, a mean of 52.5+/-15 days after transplant and 44.7+/-14 days after the beginning of ALA treatment. The median antigenemia count was 7 positive cells/300,000 neutrophils (range: 1-227). Antigenemia preceded clinical symptoms by 5.8 days (0-28 days). Eighteen (75%) of 24 positive patients received ganciclovir treatment: 8 patients (26.7%) for viral syndrome, 2 patients (33.3%) for invasive disease, and 8 patients (26.7%) as part of preemptive therapy, asymptomatic with high antigenemia values. Six pp65-positive patients with low counts were followed up until a negative result and remained asymptomatic without any specific treatment. CONCLUSION: CMV infection was frequent after ALA treatment in this group and generally occurred late after completion of treatment. Antigenemia was a reliable tool to guide preemptive treatment in these patients, and such strategy is an alternative option compared to the prophylactic use of ganciclovir with ALA treatment.     

Ganciclovir therapy in cytomegalovirus (CMV) infection in immunocompetent pediatric patients.

OBJECTIVES: To evaluate the outcome of immunocompetent pediatric patients who had positive cytomegalovirus (CMV) antigenemia and received ganciclovir. METHODS: A retrospective review was done of patients who had a CMV infection based on positive antigenemia. Medical charts were reviewed for the following information: age, sex, underlying disease, symptoms and signs, laboratory results, complementary diagnostic procedures, duration and dose of ganciclovir therapy, concomitant medications, complications, and outcome. RESULTS: Sixty-four patients with positive CMV antigenemia were identified; 15 patients were excluded from the study because of their underlying diseases. Of the remaining 49 patients, 26 (53%) were female; the median age was 11.5 months (range 0.3-132 months). Sixty-one percent (30/49) of these patients received ganciclovir (5-10 mg/kg/day) for a median of 14 days (range 7-42 days). Clinical findings included: fever, anemia, hepatomegaly, failure to thrive, elevated liver enzymes, splenomegaly, seizures, and thrombocytopenia. Sixty-three percent (19/30) of the treated patients had negative antigenemia at the end of therapy. CMV antigenemia remained positive in six (20%) patients. Nine patients received a second course of ganciclovir. CONCLUSIONS: Ganciclovir was effective in 80% of patients, as determined by negative antigenemia at the end of therapy.     

Risk factors of cytomegalovirus infection after living donor liver transplantation

BACKGROUND/AIMS: Cytomegalovirus (CMV) infection is one of the most common infectious diseases complicating liver transplantation. Data regarding the incidence and results after CMV infection or disease after living donor liver transplantation, however, are limited. METHODOLOGY: A total of 169 patients who underwent living donor liver transplantation in. our department were enrolled in the study. All of the patients were preemptively treated with intravenous ganciclovir (10mg/kg/d) when the pp65 antigenemia assay was positive. The incidence of CMV infection and disease, and risk factors for CMV infection were evaluated. RESULTS: The incidence of CMV infection and CMV disease was 44% and 3%, respectively. Acute rejection was significantly associated with CMV infection. CONCLUSIONS: The incidence of CMV disease was low, suggesting that our strategy might be effective for preventing the development of CMV disease.     

Oral versus intravenous ganciclovir for the prophylaxis of cytomegalovirus disease after allogeneic bone marrow transplantation

Abstract
Background:  Prophylactic low dose i.v. ganciclovir in patients at risk after allogeneic bone marrow transplantation (BMT) is highly effective in the prevention of cytomegalovirus (CMV) disease and infection.
Aim:  In this study, we sought to assess the tolerability of oral ganciclovir in patients after allogeneic BMT.
Methods:  CMV seropositive patients or those with CMV seropositive donors were randomised to be treated with i.v. ganciclovir 5 mg/kg three times weekly or oral ganci­clovir 3 g daily from engraftment to day 84. The period of accrual was from May 1997 to October 1998. Patients were monitored for CMV infection by weekly serology. Thirty-one patients received oral ganciclovir and 27 patients received i.v. ganciclovir, the treatment groups being balanced for clinical characteristics and prognostic factors.
Results:  Renal dysfunction, transfusion requirements and significant nausea and vomiting were not different. There were no documented cases of CMV disease during the study period although three patients developed CMV polymerase chain reaction positivity at various times. One patient treated with i.v. ganciclovir developed non-fatal gastrointestinal CMV disease after the study period on day 108. Eight patients in the oral group failed to complete planned therapy, whereas two patients failed to complete the i.v. course.
Conclusion:  We conclude that oral ganciclovir is a reasonable, well-tolerated alternative to i.v. ganciclovir for the prophylaxis of CMV disease after allogeneic BMT. (Intern Med J 2004; 34: 98−101)