器官移植病人巨細胞病毒感染之預防與治療

Prophylaxis and Treatment for Cytomegalovirus Infection in Solid Organ Transplant Recipients

劉媖媚(Ying-Mei Liu) ； 陳秀菊(Hsiu-Chu Chen) ； 施智源(Zhi-Yuan Shi) ； 吳明芬(Ming-Fen Wu) ； 劉文雄(Wen-Shyong Liou)

《臺灣臨床藥學雜誌》 28卷1期 (2020/01) Pp. 10-19

https://doi.org/10.6168/FJCP.202001_28(1).0002

摘要

巨細胞病毒（cytomegalovirus, CMV）在器官移植是一個重要的致病病毒，它會增加病人的罹病率及死亡率。若未給與抗病毒藥物預防，CMV感染與感染症最常發生於器官移植後的最初3個月內。CMV感染症之發生率及嚴重度會因免疫抑制劑的使用型態、捐贈者及受贈者的CMV血清學狀態，以及不同型態的器官移植而異。術前血清學檢查CMV-immunoglobulin G（IgG）陰性之受贈者接受了CMV-IgG陽性捐贈者的器官（D+/R-），發生CMV感染症的風險最高。預防CMV感染的目的是為了減少標的器官罹病及與其相關的死亡率，兩種主要預防策略是預防性給與抗病毒藥物（antiviral prophylaxis）與先發性治療（preemptive therapy）。靜脈注射（intravenous, IV）ganciclovir及口服valganciclovir是預防及治療移植後CMV感染的第一線用藥，而foscarnet及cidofovir因腎毒性較大，保留於治療具抗藥性或頑固型的CMV感染時使用。

關鍵字

巨細胞病毒 ； 器官移植 ； CMV感染 ； 抗病毒藥物預防 ； 先發性治療

並列摘要

Cytomegalovirus (CMV) is an important viral pathogen after solid organ transplantation (SOT), which causes significant morbidity and mortality. CMV infection and disease occur most often during the first 3 months after SOT, if without antiviral prevention. The risk of CMV disease is highest in CMV-seronegative SOT recipient, who receives a latently infected organ from a CMV-seropositive donor (D+/R-). The incidence and severity of CMV infection and disease vary with types of immunosuppressive regimen, serology status of recipient and donor, and types of organ transplantation. The aim of CMV prevention strategy is to decrease end-organ disease and related mortality. Antiviral prophylaxis and preemptive therapy are the two major strategies. Intravenous ganciclovir and oral valganciclovir are used as the first-line medications for CMV prevention and therapy. Foscarnet and cidofovir are associated with significant nephrotoxicity, therefore they are reserved for the treatment of refractory and resistant CMV infection.

並列關鍵字

Cytomegalovirus (CMV) ； Solid Organ Transplantation ； CMV Infection ； Antiviral Prophylaxis ； Preemptive Therapy