• 1.重慶醫(yī)科大學(xué)附屬第二醫(yī)院肝膽外科（重慶400010）;;
  • 2.四川大學(xué)華西醫(yī)院普外科（成都610041）;

目的  探討臨床肝移植后巨細(xì)胞病毒（CMV）感染的一般特征、臨床表現(xiàn)以及診斷和防治方法。
方法  檢索近10年來(lái)國(guó)內(nèi)、外有關(guān)文獻(xiàn)并綜述。
結(jié)果  臨床肝移植后發(fā)生CMV感染率較高，常并發(fā)其它類型的感染性疾病，其臨床表現(xiàn)無(wú)特異性，對(duì)CMV感染的早期診斷和防治尚缺乏有效措施。
結(jié)論  CMV是臨床肝移植后最重要的機(jī)會(huì)致病病毒，重視術(shù)前、術(shù)后CMV感染的監(jiān)測(cè)，積極預(yù)防和早期治療是關(guān)鍵。

引用本文： 彭勇,龔建平,嚴(yán)律南. 肝移植后巨細(xì)胞病毒感染. 中國(guó)普外基礎(chǔ)與臨床雜志, 2004, 11(5): 409-412. doi: 復(fù)制

1. Sarcinella L, Mazzulli T, Willey B, et al. Cytomegalovirus glycoprotein B genotype does not correlate with outcomes in liver transplant patients [J]. J Clin Virol, 2002; 24(1-2)∶99.
2. Turgeon N, Fishman JA, Doran M, et al. Prevention of recurrent cytomegalovirus disease in renal and liver transplant recipients: effect of oral ganciclovir [J]. Transpl Infect Dis, 2000; 2(1)∶2.
3. Falagas ME, Snydman DR, Ruthazer R, et al. Primary cytomegalovirus infection in liver transplant recipients: comparison of infections transmitted via donor organs and via transfusions. Boston Center for Liver Transplantation CMVIG Study Group [J]. Clin Infect Dis, 1996; 23(2)∶292.
4. Portela D, Patel R, LarsonKeller JJ, et al. OKT3 treatment for allograft rejection is a risk factor for cytomegalovirus disease in liver transplantation [J]. J Infect Dis, 1995; 171(4)∶1014.
5. Mutimer DJ, Shaw J, O’Donnell K, et al. Enhanced (cytomegalovirus) viral replication after transplantation for fulminant hepatic failure [J]. Liver Transpl Surg, 1997; 3(5)∶506.
6. Paterson DL, Staplefeldt WH, Wagener MM, et al. Intraoperative hypothermia is an independent risk factor for early cytomegalovirus infection in liver transplant recipients [J]. Transplantation, 1999; 67(8)∶1151.
7. Everson GT, Kam I. Liver transplantation: current status and unresolved controversies [J]. Adv Intern Med, 1997; 42∶505.
8. Satou J, Funato T, Satoh N, et al. Quantitative PCR determination of human cytomegalovirus in blood cells [J]. J Clin Lab Anal, 2001; 15(3)∶122.
9. Piiparinen H, Hockerstedt K, Lappalainen M, et al. Monitoring of viral load by quantitative plasma PCR during active cytomegalovirus infection of individual liver transplant patients [J]. J Clin Microbiol, 2002; 40(8)∶2945.
10. Mendez JC, Espy MJ, Smith TF, et al. Evaluation of PCR primers for early diagnosis of cytomegalovirus infection following liver transplantation [J]. J Clin Microbiol, 1998; 36(2)∶526.
11. Niubo J, Perez JL, MartinezLacasa JT, et al. Association of quantitative cytomegalovirus antigenemia with symptomatic infection in solid organ transplant patients [J]. Diagn Microbiol Infect Dis, 1996; 24(1)∶19.
12. Kusne S, Grossi P, Irish W, et al. Cytomegalovirus PP65 antigenemia monitoring as a guide for preemptive therapy: a cost effective strategy for prevention of cytomegalovirus disease in adult liver transplant recipients [J]. Transplantation, 1999; 68(8)∶1125.
13. Singhal S, Shaw JC, Ainsworth J, et al. Direct visualization and quantitation of cytomegalovirusspecific CD8+ cytotoxic Tlymphocytes in liver transplant patients [J]. Transplantation, 2000; 69(11)∶2251.
14. Benz C, Utermohlen O, Wulf A, et al. Activated virusspecific T cells are early indicators of antiCMV immune reactions in liver transplant patients [J]. Gastroenterology, 2002; 122(5)∶1201.
15. Dockrell DH, Prada J, Jones MF, et al. Seroconversion to human herpesvirus 6 following liver transplantation is a marker of cytomegalovirus disease [J]. J Infect Dis, 1997; 176(5)∶1135.
16. Lautenschlager I, Hockerstedt K, Jalanko H, et al. Persistent cytomegalovirus in liver allografts with chronic rejection [J]. Hepatology, 1997; 25(1)∶190.
17. van den Berg AP, Klompmaker IJ, Haagsma EB, et al. Evidence for an increased rate of bacterial infections in liver transplant patients with cytomegalovirus infection [J]. Clin Transplant, 1996; 10(2)∶224.
18. Gavalda J, de Otero J, Murio E, et al. Two grams daily of oral acyclovir reduces the incidence of cytomegalovirus disease in CMVseropositive liver transplant recipients [J]. Transpl Int, 1997; 10(6)∶462.
19. Winston DJ, Wirin D, Shaked A, et al. Randomised comparison of ganciclovir and highdose acyclovir for longterm cytomegalovirus prophylaxis in livertransplant recipients [J]. Lancet, 1995; 346(8967)∶69.
20. Badley AD, Seaberg EC, Porayko MK, et al. Prophylaxis of cytomegalovirus infection in liver transplantation: a randomized trial comparing a combination of ganciclovir and acyclovir to acyclovir. NIDDK Liver Transplantation Database [J]. Transplantation, 1997; 64(1)∶66.
21. Kanj SS, Sharara AI, Clavien PA, et al. Cytomegalovirus infection following liver transplantation: review of the literature [J]. Clin Infect Dis,,1996; 22(3)∶537.
22. Tarp BD, Astrup LB. Should recurrent cytomegalovirus infections in patients with liver transplantation be treated? [J]. Ugeskr Laeger, 1997; 159(22)∶3413.
  1. 1. Sarcinella L, Mazzulli T, Willey B, et al. Cytomegalovirus glycoprotein B genotype does not correlate with outcomes in liver transplant patients [J]. J Clin Virol, 2002; 24(1-2)∶99.
  2. 2. Turgeon N, Fishman JA, Doran M, et al. Prevention of recurrent cytomegalovirus disease in renal and liver transplant recipients: effect of oral ganciclovir [J]. Transpl Infect Dis, 2000; 2(1)∶2.
  3. 3. Falagas ME, Snydman DR, Ruthazer R, et al. Primary cytomegalovirus infection in liver transplant recipients: comparison of infections transmitted via donor organs and via transfusions. Boston Center for Liver Transplantation CMVIG Study Group [J]. Clin Infect Dis, 1996; 23(2)∶292.
  4. 4. Portela D, Patel R, LarsonKeller JJ, et al. OKT3 treatment for allograft rejection is a risk factor for cytomegalovirus disease in liver transplantation [J]. J Infect Dis, 1995; 171(4)∶1014.
  5. 5. Mutimer DJ, Shaw J, O’Donnell K, et al. Enhanced (cytomegalovirus) viral replication after transplantation for fulminant hepatic failure [J]. Liver Transpl Surg, 1997; 3(5)∶506.
  6. 6. Paterson DL, Staplefeldt WH, Wagener MM, et al. Intraoperative hypothermia is an independent risk factor for early cytomegalovirus infection in liver transplant recipients [J]. Transplantation, 1999; 67(8)∶1151.
  7. 7. Everson GT, Kam I. Liver transplantation: current status and unresolved controversies [J]. Adv Intern Med, 1997; 42∶505.
  8. 8. Satou J, Funato T, Satoh N, et al. Quantitative PCR determination of human cytomegalovirus in blood cells [J]. J Clin Lab Anal, 2001; 15(3)∶122.
  9. 9. Piiparinen H, Hockerstedt K, Lappalainen M, et al. Monitoring of viral load by quantitative plasma PCR during active cytomegalovirus infection of individual liver transplant patients [J]. J Clin Microbiol, 2002; 40(8)∶2945.
  10. 10. Mendez JC, Espy MJ, Smith TF, et al. Evaluation of PCR primers for early diagnosis of cytomegalovirus infection following liver transplantation [J]. J Clin Microbiol, 1998; 36(2)∶526.
  11. 11. Niubo J, Perez JL, MartinezLacasa JT, et al. Association of quantitative cytomegalovirus antigenemia with symptomatic infection in solid organ transplant patients [J]. Diagn Microbiol Infect Dis, 1996; 24(1)∶19.
  12. 12. Kusne S, Grossi P, Irish W, et al. Cytomegalovirus PP65 antigenemia monitoring as a guide for preemptive therapy: a cost effective strategy for prevention of cytomegalovirus disease in adult liver transplant recipients [J]. Transplantation, 1999; 68(8)∶1125.
  13. 13. Singhal S, Shaw JC, Ainsworth J, et al. Direct visualization and quantitation of cytomegalovirusspecific CD8+ cytotoxic Tlymphocytes in liver transplant patients [J]. Transplantation, 2000; 69(11)∶2251.
  14. 14. Benz C, Utermohlen O, Wulf A, et al. Activated virusspecific T cells are early indicators of antiCMV immune reactions in liver transplant patients [J]. Gastroenterology, 2002; 122(5)∶1201.
  15. 15. Dockrell DH, Prada J, Jones MF, et al. Seroconversion to human herpesvirus 6 following liver transplantation is a marker of cytomegalovirus disease [J]. J Infect Dis, 1997; 176(5)∶1135.
  16. 16. Lautenschlager I, Hockerstedt K, Jalanko H, et al. Persistent cytomegalovirus in liver allografts with chronic rejection [J]. Hepatology, 1997; 25(1)∶190.
  17. 17. van den Berg AP, Klompmaker IJ, Haagsma EB, et al. Evidence for an increased rate of bacterial infections in liver transplant patients with cytomegalovirus infection [J]. Clin Transplant, 1996; 10(2)∶224.
  18. 18. Gavalda J, de Otero J, Murio E, et al. Two grams daily of oral acyclovir reduces the incidence of cytomegalovirus disease in CMVseropositive liver transplant recipients [J]. Transpl Int, 1997; 10(6)∶462.
  19. 19. Winston DJ, Wirin D, Shaked A, et al. Randomised comparison of ganciclovir and highdose acyclovir for longterm cytomegalovirus prophylaxis in livertransplant recipients [J]. Lancet, 1995; 346(8967)∶69.
  20. 20. Badley AD, Seaberg EC, Porayko MK, et al. Prophylaxis of cytomegalovirus infection in liver transplantation: a randomized trial comparing a combination of ganciclovir and acyclovir to acyclovir. NIDDK Liver Transplantation Database [J]. Transplantation, 1997; 64(1)∶66.
  21. 21. Kanj SS, Sharara AI, Clavien PA, et al. Cytomegalovirus infection following liver transplantation: review of the literature [J]. Clin Infect Dis,,1996; 22(3)∶537.
  22. 22. Tarp BD, Astrup LB. Should recurrent cytomegalovirus infections in patients with liver transplantation be treated? [J]. Ugeskr Laeger, 1997; 159(22)∶3413.