| Autor: |
Plotkin, Stanley A., Starr, Stuart E., Friedman, HArvey M., Brayman, Kenneth, Harris, Sandra, Jackson, Stephanie, Tustin, Nancy B., Grossman, Robert, Dafoe, Donald, Barker, Clyde, Plotkin, S A, Starr, S E, Friedman, H M, Brayman, K, Harris, S, Jackson, S, Tustin, N B, Grossman, R, Dafoe, D, Barker, C |
| Předmět: |
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| Zdroj: |
Annals of Internal Medicine; 4/1/91, Vol. 114 Issue 7, p525-531, 7p, 4 Charts, 1 Graph |
| Abstrakt: |
Objective: To test the efficacy of vaccination with the Towne live attenuated cytomegalovirus vaccine.Design: A double-blind, randomized, placebo-controlled trial in candidates for renal transplantation. The cytomegalovirus serologic status of both recipients and donors were determined, and the recipients were followed for periods of 6 months to 7 years after transplant.Setting: A university transplant center.Patients: The analyses were made on 237 patients who were given either vaccine or placebo, received renal transplants, and were followed for at least 6 months.Intervention: Subcutaneous inoculation with Towne live attenuated virus or with placebo.Main Outcome Measures: The presence of cytomegalovirus infection was defined by virus isolation and antibody tests. If infection occurred, a prearranged scoring system for cytomegalovirus disease was used to objectify disease severity.Results: The vaccine was well tolerated, and there were no discernible long-term adverse effects. Recipients who were originally seropositive did not clearly benefit from vaccination. Protective efficacy was analyzed in the group at highest risk for cytomegalovirus disease; recipients who were seronegative at the time of vaccination and who received a kidney from a seropositive donor. Compared with placebo recipients, vaccinated patients in this group had significantly less severe cytomegalovirus disease, with a significant reduction in disease scores (P = 0.03) and 85% decrease in the most severe disease (95% CI, 35% to 96%), although infection rates were similar. Graft survival at 36 months was improved in vaccinated recipients of cadaver kidneys (8 of 16) compared with unvaccinated recipients (4 of 16) (P = 0.04).Conclusions: Previous vaccination of seronegative renal transplant recipients with live cytomegalovirus results in reduction of disease severity mimicking the action of naturally derived immunity. [ABSTRACT FROM AUTHOR] |
| Databáze: |
Complementary Index |
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