Abstract:

Objective To summarize cytomegalovirus（CMV）infection in organ donation and kidneytransplantation after the death of citizens，and to analyze of the effectiveness and safety of prevention and preemptive treatment. Methods Among the 243 patients who received the donation after citizen’s death（DD）allogeneic kidney transplantation for the first time in our hospital，90 patients who met the research criteria were selected，according to different CMV viral loads，they were divided into CMV preventive treatment group （group A ：40 cases），CMV infection preemptive treatment group（group B ：34 cases），and negative control group（Group C ：16 cases）with no evidence of CMV infection，the characteristics of CMV infection，the correlation with Tac trough concentration（C0）and the consistence between CMV low matrix phosphorylation protein 65 （pp65） antigenemia and CMV-DNA were observed. The safety and effectiveness of preventivetreatment with low-dose valganciclovir（450 mg/d or 450 mg/2 d）and preemptive treatment with standard dose ganciclovir〔8 ～ 10 mg/（kg·d）〕were also analyzed. Results The total incidence of CMV infection after DD renal transplantation was 82.22% （74/90）， and the incidence of CMV infection within three months after transplantation was 90%（36/40）in group A and 94.11%（32/34）in group B（χ2 ＝ 0.0481， P＞0.05），the time of CMV infection was（65.62 ±45.74）d in patients induced by Baliximab and（33.06 ± 20.11）d in rATG group（t ＝ 2.9922，P ＜ 0.01），there was no correlation between Tac C0 and CMV infection（F ＝ 0.2 879，P ＞ 0.05）. The positive coincidence rate between CMV-PP65 antigenemia and CMV-DNA was 96.4%，and the total coincidence rate was 65.5%；the absolute values of CD8+ T cells（Ts/Tc）and NK cells in CMV-pp65 antigenemiapositive samples were lower than those in pp65 negative samples（P ＜ 0.05）.There was no significant difference in the effectiveness，adverse reactions and acute rejection（AR）between low-dose valganciclovir and standard dose ganciclovir for prevention and preemptive treatment after DD renal transplantation（P ＞ 0.05）. Conclusion Low dose valganciclovir and standard dose ganciclovir are safe and effective in the prevention and preemptive treatment ofDD renal transplantation. With the active monitoring of postoperative CMV infection，the absolute values of CMVpp65，CD8+ T cells（TS / TC）and NK cells can help diagnose CMV infection more timely and accurately. 

Key words:

Deceased donor kidney transplantation , Cytomegalovirus infection , Valganciclovirhydrochloride tablets, T lymphocyte, NK cells

摘要：

目的 总结公民逝世后器官捐献供肾移植中巨细胞病毒（cytomegalovirus，CMV）感染情况分析及预防、抢先治疗的有效性和安全性。方法 回顾分析自 2018 年 1 月 1 日至 2021 年 12 月 30 日在本院首次行公民逝世后器官捐献（deceased donor，DD）异体肾移植 243 例患者中，挑选符合研究标准的90 例患者资料，将其按照 CMV 病毒载量不同，分为 CMV 预防治疗组（A 组）40 例，CMV 感染抢先治疗组（B 组）34 例，无 CMV 感染证据的阴性对照组（C 组）16 例，对比观察术后 CMV 感染特点、与他克莫司（tacrolimus，Tac）谷浓度（C0）相关性、CMV 低基质磷酸化蛋白（low matrix phosphoprotein 65，pp65）抗原血症结果与 CMV-DNA 的一致性以及低剂量缬更昔洛韦（450 mg/d 或 450 mg/2 d）预防治疗、标准剂量更昔洛韦〔8 ～10 mg/（kg·d）〕抢先治疗的安全性和有效性等。结果 CMV 感染在 DD 肾移植术后总发生率为82.22%（74/90），发生于术后 3 个月内的比例：A 组为 90%（36/40），B 组 94.11%（32/34，χ2 ＝ 0.0481，P ＞ 0.05）， 使用巴利昔单抗诱导的患者，CMV 感染发生时间为（65.62±45.74）d，使用 rATG 组为（33.06±20.11）d （t ＝ 2.9922，P ＜ 0.01），Tac 的 C0 与 CMV 是否感染无相关性（F ＝ 0.2 879，P ＞ 0.05），CMV-pp65 抗原血症结果与 CMV-DNA 的阳性符合率为 96.4%，总符合率为 65.5%。CMV-pp65 抗原血症阳性的样本 CD8+ T 细胞（Ts/Tc）绝对值及 NK 细胞绝对值均低于 pp-65 阴性的样本，差异有统计学意义（P ＜ 0.05）。低剂量的缬更昔洛韦及标准剂量更昔洛韦用于 DD 肾移植术后预防及抢先治疗在有效性、不良反应、急性排斥反应（acute rejection，AR）方面对比，差异无统计学意义（P ＞ 0.05）。结论 低剂量的缬更昔洛韦及标准剂量更昔洛韦用于 DD 肾移植术后预防及抢先治疗中安全有效。在积极监测术后CMV 感染中，CMV-pp65、CD8+ T 细胞（Ts/Tc）绝对值、NK 细胞绝对值能够更及时、准确地帮助诊断 CMV 感染。

关键词:

DD 肾移植 , 巨细胞病毒感染 , 缬更昔洛韦 , T 淋巴细胞 , NK 细胞