低剂量缬更昔洛韦对CMV R+肺移植受者的疗效:回顾性比较分析。

IF 2.3 Multidisciplinary Respiratory Medicine Pub Date : 2021-01-25 eCollection Date: 2021-01-15 DOI:10.4081/mrm.2021.706
Jessica Hunt, Kristina M Chapple, Aasya Nasar, Lauren Cherrier, Rajat Walia
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引用次数: 1

摘要

背景:巨细胞病毒(CMV)感染在肺移植术后极为常见,可导致显著的发病率和死亡率。目前的实践建议使用每日900毫克的缬更昔洛韦预防巨细胞病毒,但没有文献评估每日450毫克的缬更昔洛韦对中度巨细胞病毒风险肺移植受体是否足够。因此,我们试图评估低剂量缬更昔洛韦(LDV)与高剂量缬更昔洛韦(HDV)预防在中等风险(R+)患者中的作用。方法:我们对亚利桑那州凤凰城诺顿胸科研究所的肺移植受者进行了回顾性分析,观察接受缬更昔洛韦450 mg/天(LDV)或900 mg/天(HDV)的中等风险患者。所有患者移植后随访1年,观察巨细胞病毒血症的发生率。主要终点是CMV病毒血症率,由CMV聚合酶链反应阳性([PCR] >2.7 log拷贝/mL)确定。次要结局包括不良事件发生率、急性细胞排斥反应和死亡率。结果:初步分析纳入103例患者(LDV组55例,HDV组48例)。在LDV组中,9名患者(16.4%)发生巨细胞病毒血症,而HDV组中有4名患者(8.3%)发生巨细胞病毒血症(p=0.221),两组之间的不良事件发生率无差异。结论:两组间主要转归无统计学差异。然而,该分析显示的效应大小可能具有临床相关性,目前不推荐缬更昔洛韦450 mg /天用于中度风险肺移植受者。为了证实我们的结果,需要进一步的前瞻性研究,纳入更大的患者群体。
本文章由计算机程序翻译,如有差异,请以英文原文为准。

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Efficacy of low-dose valganciclovir in CMV R+ lung transplant recipients: a retrospective comparative analysis.

Background: Cytomegalovirus (CMV) infection is extremely common after lung transplant and can be associated with significant morbidity and mortality. Current practice suggests the use of 900 mg daily of valganciclovir for CMV prophylaxis, but there is no literature assessing whether 450 mg daily of valganciclovir is sufficient in intermediate CMV risk lung transplant recipients. Therefore, we sought to assess the role of low-dose valganciclovir (LDV) versus high-dose valganciclovir (HDV) prophylaxis in intermediate-risk (R+) recipients.

Methods: We conducted a retrospective analysis on lung transplant recipients at the Norton Thoracic Institute in Phoenix, Arizona looking at intermediate-risk patients that received either valganciclovir 450 mg per day (LDV) or 900 mg/day (HDV). All patients were followed for 1 year post-transplant for incidence of CMV viremia. The primary outcome was the rate of CMV viremia as determined by a positive CMV polymerase chain reaction ([PCR] >2.7 log copies/mL). Secondary outcomes included rate of adverse events, acute cellular rejection, and mortality.

Results: The primary analysis included 103 patients (55 in the LDV group, 48 in the HDV group). In the LDV group, 9 patients (16.4%) developed CMV viremia compared to 4 (8.3%) in the HDV group (p=0.221) with no difference observed in adverse event rates between groups.

Conclusion: There was no statistical difference between groups for the primary outcome. However, the effect size demonstrated in this analysis may be of clinical relevance and valganciclovir 450 mg daily would not be recommended in intermediate risk lung transplant recipients at this time. To confirm our results, further prospective studies enrolling larger patient populations are necessary.

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来源期刊
Multidisciplinary Respiratory Medicine
Multidisciplinary Respiratory Medicine Medicine-Pulmonary and Respiratory Medicine
自引率
0.00%
发文量
23
期刊介绍: Multidisciplinary Respiratory Medicine is the official journal of the Italian Respiratory Society - Società Italiana di Pneumologia (IRS/SIP). The journal publishes on all aspects of respiratory medicine and related fields, with a particular focus on interdisciplinary and translational research. The interdisciplinary nature of the journal provides a unique opportunity for researchers, clinicians and healthcare professionals across specialties to collaborate and exchange information. The journal provides a high visibility platform for the publication and dissemination of top quality original scientific articles, reviews and important position papers documenting clinical and experimental advances.
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