EARLY DETECTION OF PRIMARY CYTOMEGALOVIRUS-INFECTION AFTER HEART AND KIDNEY-TRANSPLANTATION AND THE INFLUENCE OF HYPERIMMUNE GLOBULIN PROPHYLAXIS

被引:15
作者
BOLAND, GJ
VERVERS, C
HENE, RJ
JAMBROES, G
DONCKERWOLCKE, RAMG
DEGAST, GC
机构
[1] Department of Immuno-Hematology, University Hospital Utrecht, Utrecht, NL-3508 GA
[2] Department of Nephrology, University Hospital Utrecht, Utrecht, NL-3508 GA
[3] Department of Cardiology, University Hospital Utrecht, Utrecht, NL-3508 GA
[4] Department of Nephrology, Wilhelmina Children's Hospital, Utrecht
关键词
CMV; HYPERIMMUNOGLOBULIN PROPHYLAXIS; KIDNEY TRANSPLANTATION; HEART TRANSPLANTATION;
D O I
10.1007/BF00336637
中图分类号
R61 [外科手术学];
学科分类号
摘要
A randomized study of prophylaxis with hyperimmune (globulin (HIg) was performed in 28 cytomegalovirus CMV)-seronegative heart and kidney recipients with CMV-seropositive donors who were extensively monitored for active CMV infection and CMV disease. Detection of CMV antigen in peripheral blood granulocytes (antigenemia) was the first sign of primary CMV infection, generally occurring several weeks before IgM or IgG anti-CMV antibodies were detected and before positive cultures appeared. A correlation was found between rejection treatment with OKT3 or ATG, severity of CMV disease, and graft loss. Rejection treatment had no influence on incidence of CMV transmission. Primary CMV infection occurred most often in older patients with older donors. No beneficial effects were seen with HIg prophylaxis, which was administered from week 1 until week 7 after transplantation. Incidence of primary CMV infection was equal in both groups (50%) and no influence on the severity of primary CMV infection was seen. The only effect that was seen was on the time from transplantation to detection of active CMV infection, which was prolonged by HIg prophylaxis.
引用
收藏
页码:34 / 38
页数:5
相关论文
共 26 条
  • [1] Betts R.F., Freeman R.B., Douglas R.G., Talley T.E., Rundell B., Transmission of cytomegalovirus infection with renal allograft, Kidney Int, 8, pp. 387-394, (1975)
  • [2] Boland G.J., de Gast G.C., Hene R.J., Jambroes G., Donckerwolcke R., The T.H., Mudde G.C., Early detection of active cytomegalovirus (CMV) infection after heart and kidney transplantation by testing for immediate early antigenemia and influence of cellular immunity on the occurrence of CMV infection, J Clin Microbiol, 28, pp. 2069-2075, (1990)
  • [3] Chou S., Norman D.J., The influence of donor factors other than serologic status on transmission of cytomegalovirus to transplant recipients, Transplantation, 46, pp. 89-93, (1988)
  • [4] Davis C.L., The prevention of cytomegalovirus disease in renal transplantation, Am J Kidney Dis, 16, pp. 175-188, (1990)
  • [5] Dunn D.L., Mayoral J.L., Gillingham K.J., Loeffler C.M., Brayman K.L., Kramer M.A., Erice A., Balfour H.H., Fletcher C.V., Bolman R.M., Matas A.J., Payne W.D., Sutherland D.E.R., Najarian J.S., Treatment of invasive cytomegalovirus disease in solid organ transplant patients with ganciclovir, Transplantation, 51, pp. 98-106, (1991)
  • [6] Freeman R., Gould F.K., McMaster A., Management of cytomegalovirus antibody negative patients undergoing heart transplantation, J Clin Pathol, 43, pp. 373-376, (1990)
  • [7] Grattan M.T., Moreno-Cabral C.E., Starne V.A., Oyer D.E., Stinson E.B., Shamway N.E., Cytomegalovirus infection is associated with cardiac allograft rejection and atherosclerosis, JAMA, 261, pp. 3561-3566, (1989)
  • [8] Griffiths P.D., Panjwani D.D., Stirk P.R., Bull M.G., Ganczakowski M., Blacklock H.A., Prentice H.G., Rapid diagnosis of cytomegalovirus infection in immuno-compromised patients with detection of early antigen fluorescent foci, Lancet, 2, pp. 1242-1245, (1984)
  • [9] Grundy J.E., Lui S.F., Super M., Berry N.J., Sweny P., Fernando O.N., Moorhead J., Griffiths P.D., Symptomatic cytomegalovirus infection in seropositive kidney recipients: reinfection with donor virus rather than reactivation of recipient virus, Lancet, 2, pp. 132-135, (1988)
  • [10] Ho M., Suwansirikul S., Dowling J.N., Youngblood L.A., Artrong J.A., The transplanted kidney as a source of cytomegalovirus infection, N Engl J Med, 293, pp. 1109-1112, (1975)