巨細(xì)胞病毒的指南

1、巨細(xì)胞病毒的指南第1頁，共15頁，2022年，5月20日，4點44分，星期三Why we should pay attention to CMV?In the absence of preventive measures, 40%-100% of all KTRs develop CMV infection and up to 67% develop CMV disease.The mortality can be 90% without effective treatment.第2頁，共15頁，2022年，5月20日，4點44分，星期三Why the morbidity of CMV can

2、 be so high?The seroprevalence of CMV in the general population ranges from 30%-97% and increases with age.After primary infection, the virus establishes alifelong latency within the host.Risk for CMV after transplantation is strongly dependent on donor (D) and recipient (R) serology, with patients

3、who are D+/R,D+/R+ or D/R+ at risk for developing CMV infection and disease, and D+/R at highest risk for severe CMV disease.第3頁，共15頁，2022年，5月20日，4點44分，星期三How the CMV transmit? CMV can be transmitted through saliva, urine, sexual contact, placental transfer, breastfeeding, blood transfusion, solid-o

4、rgan transplantation, or hematopoietic stem cell transplantation.第4頁，共15頁，2022年，5月20日，4點44分，星期三How diagnosis CMV disease?Cytomegalovirus disease is defined by the presence of clinical signs and symptoms attributable to CMV infection, and the presence of CMV in plasma by NAT or pp65 antigenemia. What

5、 is the clinical signs and symptoms of CMV disease?第5頁，共15頁，2022年，5月20日，4點44分，星期三What is the clinical signs and symptoms of CMV disease?In KTRs, CMV disease can manifest as CMV syndrome, characterized by fever, atypical lymphocytosis, neutropenia or thrombocytopenia, and malaise, or as tissue-invasi

6、ve disease (pneumonia, gastrointestinal disease, hepatitis, pancreatitis, encephalitis, chorioretinitis, myocarditis ,nephritis, cystitis, or mucocutaneous disease)第6頁，共15頁，2022年，5月20日，4點44分，星期三What is pp65?The antigenemia assay is a rapid semiquantitativeimmunofluorescent assay that detects phospho

7、protein 65 (pp65) produced in CMV -infected polymorphonuclear leukocytes in peripheral blood.第7頁，共15頁，2022年，5月20日，4點44分，星期三Which period of time CMV occur most often?Infection and disease occur most often in the first 100 days after transplantation, at the time of the highest immunosuppressive load.第

8、8頁，共15頁，2022年，5月20日，4點44分，星期三CMV prophylaxis: We recommend that KTRs (except when donor and recipient both have negative CMV serologies) receive chemoprophylaxis for CMV infection with oral ganciclovir or valganciclovir for at least 3 months after transplantation,(1B) and for 6 weeks after treatment

9、 with a T-celldepleting antibody. (1C)第9頁，共15頁，2022年，5月20日，4點44分，星期三CMV prophylaxis: In patients with CMV disease, we suggest weekly monitoring of CMV by NAT or pp65 antigenemia. (2D)第10頁，共15頁，2022年，5月20日，4點44分，星期三CMV treatment: 1.We recommend that all patients with serious(including most patients w

10、ith tissue invasive) CMV disease be treated with intravenous ganciclovir. (1D) 2. We recommend that CMV disease in adult KTRs that is not serious (e.g. episodes that are associated with mild clinical symptoms) be treated with either intravenous ganciclovir or oral valganciclovir. (1D)第11頁，共15頁，2022年

11、，5月20日，4點44分，星期三CMV treatment: 3.We recommend that all CMV disease in pediatric KTRs be treated with intravenous ganciclovir. (1D) 4.We suggest continuing therapy until CMV is no longer detectable by plasma NAT or pp65 antigenemia. (2D) 第12頁，共15頁，2022年，5月20日，4點44分，星期三We suggest reducing immunosuppressive medication in life-threatening CMV disease, and CMV disease that persists in the face of treatment, until CMV disease has resolved. (2D)We suggest monitoring graft function closely during CMV disease. (2D) immunosuppressive medication第13頁，共15頁，2022年，5月20日，4點44分，星期三Ac