| [Objective]CMV infection is one of the most frequent opportunistic infections in liver transplant recipients,the morbidity and the fatality rate of CMV infection is high.It affects the survival rate and survival time post the operation.To understand more about the affection of the prophylactic anti-CMV medicines to CMV infection and CMV disease,in the research,we need to conclude the incidence of CMV infection and CMV disease among the post-transplantation patients and evaluate the validity of the prophylactic therapies.We intend to find the best way to prevent the CMV infection and CMV disease.[Methods]A schedule table was made to retrospectively investigate the 329 liver transplantation patients from January 2004 to March 2007 in Zhongshan Hospital.We use the Spss11.0 to analyze the data.We conclude:①The morbidity of CMV infection and CMV disease post the liver transplantation;②The validity of ganciclovir(GCV),acyclovir po(ACV) and ganciclovir combined with acyclovir (GCV+ACV) prophylaxis therapies in liver transplant recipients to prevent CMV infection and CMV disease;the affection of prophylactic drugs on acute or chronic rejection and biliary tract stricture,and also average hospitalization days and average hospitalization expenditures.③Compared the three prophylactic methods with each other to find out which is better on decreasing the morbidity and delaying the first time of CMV infection and CMV disease and decreasing the rates of secondary rejection and biliary tract stricture,and increasig one year survival rate and also having the least influence on leucopenia.[Result]①The total incident rate of CMV infection and CMV disease in the 309 liver transplant recipients is 25.3%.The incident rate of CMV infection is 17.2%,and CMV disease is 8.1%。The average first time of CMV infection and CMV disease is 37±34 and 36±31 days post the operation.The fatality rate of CMV disease is 32%.The survival rate in 1 year is 81.9%.②The incident rate of CMV infection and CMV disease in the prophylactic group is 12.1%and 6.6%.,and the morbidity of CMV infection and CMV disease is 42.3%and 15.4%in the non-prophylactic group (P=0.000).The fatality rate of CMV disease in the prophylactic group and non-prophylactic group is 20%and 62.5%(P=0.042).One year survival rate of prophylactic and non-prophylactic group is 84%and 71.2%(P=0.028).③In the serum positive recipients,the CMV infection rate of GCV,ACV,GCV+ACV is 10.5%,15.9%and 7.9%,which have statistic difference with the rate of the nonprophylactic group(42.3%)(P＜0.01).And the incident rates of CMV disease in the three prophylactic methods are 10.5%,8.3%and 3.2%,which also have statistic difference with the non-prophylactic group(15.4%)(P＜0.05).One year survival rates of GCV,ACV and GCV+ACV groups are 86.8%,78%and 88.9%in the serum positive recipients,and 1 year survival rate of the non-prophylactic group is71.2%.There is statistic difference between GCV+ACV group and the non-prophylactic group(P=0.021).④In the serum positive recipients,the rates of rejection reaction in the prophylactic and non-prophylactic group are 12.1%and 25%(P=0.017),OR=0.48.The rates of rejection rates in GCV,ACV,GCV+ACV groups are 13.2%,12.9%and 9.5%,and there is significant difference between ACV,GCV+ACV group and the non-prophylactic group.The rates of biliary tract stricture in the prophylactic and non-prophylactic groups are 12.6%and 28.8% (P=0.003),OR=0.44.The rates of biliary tract stricture in GCV,ACV and GCV+ACV groups are 10.5%,14.4%and 9.5%,which have significant differences with the non-prophylactic group(P=0.035,0.023 and 0.008.The rates of re-transplantation in the prophylactic and non-prophylactic group are 1.3%and 5.8%(P=0.043), OR=0.22.The average hospitalization expenditures of the prophylactic and nonprophylactic groups are RMB 127357.4±9782.1 and 195299.3±12981.5 (P=0.012).The average hospitalization expenditures of GCV,ACV and GCV+ACV groups are RMB153484.9±642486.6,126541.1±47790.6,155098.2±90370,also have significant differences with the non-prophylactic group(P=0.002,0.000,0.006).⑤Comparing the three prophylactic methods with each other in the serum positive recipients,there are statistic differences of the rates of CMV infection and CMV disease and one year survival rate between ACV and GCV+ACV groups(P=0.032 and 0.048).There are no statistic differences of the first time of CMV infection and the rates of secondary rejection and biliary tract stricture and average hospitalization expenditures among the three prophylactic groups.⑥In the serum positive recipients,the incident rates of leucopenia in the GCV,ACV and GCV+ACVgroups 31.6%,14.4%,41.2%and 13.5%.There is significant difference between GCV+ACV group and ACVgroup..There is no significant difference of the incident rate of granulocytopenia and agranulocytosis among the GCV,ACV,GCV+ACV groups.[Conclusion]①In 309 liver transplant recipients,the morbidity of CMV infection and CMV disease is 12.1%and 6.6%in the prophylactic group,and 42.3%and 15.4%in the non-prophylactic group.②In the serum positive recipients,the three different prophylactic methods(GCV 2.5mg/kg/d,ACV 0.2 tid and GCV+ACV)can lower the incidence of CMV infection and CMV disease,GCV+ACV therapy can increase one year survival rate.③In the serum positive recipients,prophylactic drugs can also decrease the probability of rejection reaction and biliary tract stricture,decrease the rate of retransplantation,and also decrease the average hospitalization expenditures.④GCV+ACV prophylactic therapy is the better way to prevent the infection of CMV in the serum positive recipients.
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