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首页> 外文期刊>Advanced studies in medicine >The impact of cytomegalovirus infection on solid organ transplantation
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The impact of cytomegalovirus infection on solid organ transplantation

机译：巨细胞病毒感染对实体器官移植的影响

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PURPOSE: To review the salient features of cytomegalovirus (CMV) infection in solid organ transplant recipients, focusing on the direct and indirect clinical effects of the infection, diagnosis, treatment, and strategies for prevention. EPIDEMIOLOGY: There is evidence of active CMV in up to 75% of transplant recipients within the first postoperative year. Patients are at highest risk if they receive a CMV-infected organ from a donor and have never had experience with CMV infection themselves. The risk of infection also varies with the type of organ transplanted. REVIEW SUMMARY: CMV is the single most important microbial pathogen that can affect a solid organ transplant recipient. As a herpesvirus, CMV has the ability to become latent, and processes that release proinflammatory mediators, such as allograft rejection, sepsis, and anti-lymphocyte antibody therapy, can reactivate it. Once the virus is actively replicating, the most important exogenous factor influencing the course of infection is the type and intensity of immunosuppressive therapy. The possible direct clinical effects of CMV infection after solid organ transplantation are fever, a mononucleosis-like syndrome, leukopenia, thrombocytopenia, pneumonitis, gastrointestinal disease, hepatitis, nephritis, carditis, pancreatitis, and retinitis. The indirect clinical effects can include acute and/or chronic allograft injury or rejection, enhanced immunosuppression predisposing the patient to other opportunistic infections, and oncogenesis. The cornerstone or viral diagnosis is the CMV viral load assay. The gold standard for treatment of CMV disease is intravenous ganciclovir, but ganciclovir-resistant infection is not an infrequent cause of late morbidity and mortality. Antiviral drugs are administered to many patients for CMV prophylaxis or preemptive therapy, but there is evidence that prevention simply delays CMV disease in predisposed patients. Strategies to reduce the incidence and impact or late-onset disease will be an important area for future research. TYPE OF AVAILABLE EVIDENCE: Nationally recognized treatment guidelines, randomized-controlled trials, randomized trials, systematic reviews/meta-analyses, prospective and retrospective cohort studies, unstructured reviews. GRADE OF AVAILABLE EVIDENCE: Good. CONCLUSION: There is increasing evidence that CMV has significant direct effects as well as indirect effects in organ transplant recipients. Prevention and treatment of CMV infection and its consequences are key to improved transplant outcomes.
机译：目的：回顾实体器官移植受者巨细胞病毒（CMV）感染的显着特征，重点研究感染的直接和间接临床影响，诊断，治疗和预防策略。流行病学：术后第一年内，有多达75％的移植受者存在活跃的CMV证据。如果患者从捐献者那里接受了CMV感染，并且自己从未经历过CMV感染，则他们的风险最高。感染的风险也随所移植器官的类型而异。综述：CMV是可以影响实体器官移植受者的最重要的微生物病原体。作为疱疹病毒，CMV具有潜伏的能力，释放促炎性介质的过程（例如同种异体移植排斥，败血症和抗淋巴细胞抗体治疗）可以重新激活它。一旦病毒活跃复制，影响感染过程的最重要的外源因素就是免疫抑制疗法的类型和强度。实体器官移植后CMV感染的可能直接临床效果是发烧，单核细胞增多症样综合征，白细胞减少症，血小板减少症，肺炎，胃肠道疾病，肝炎，肾炎，心脏炎，胰腺炎和视网膜炎。间接的临床影响可包括急性和/或慢性同种异体移植损伤或排斥反应，增强的免疫抑制作用，使患者易患其他机会性感染以及致癌作用。基石或病毒诊断是CMV病毒载量测定。治疗CMV疾病的金标准是静脉注射更昔洛韦，但更昔洛韦耐药性感染并非晚期发病和死亡的罕见原因。对许多患者进行抗病毒药物预防或预防性治疗，但有证据表明，预防仅会延迟易感患者的CMV疾病。减少发病率和影响或迟发性疾病的策略将是未来研究的重要领域。可用证据的类型：国家认可的治疗指南，随机对照试验，随机试验，系统评价/荟萃分析，前瞻性和回顾性队列研究，非结构性评价。可用的证据等级：很好。结论：越来越多的证据表明，CMV在器官移植受者中具有明显的直接作用和间接作用。预防和治疗CMV感染及其后果是改善移植结果的关键。

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