148.3 🩺 內科專科考前版

148.3.0.1 1⃣ 22E 曎新

  • Letermovir (Prevymis): prevention HSCT seropositive — FDA 2017
  • Maribavir (Livtencity): refractory CMV — FDA 2021
  • mNGS (metagenomic NGS): identification of rare/unusual pathogens in transplant FUO
  • Donor-derived infections increasing recognition: better screening but unusual transmission cases
  • CMV CAR-T in development for refractory CMV

148.3.0.2 2⃣ Strongyloides (endemic regions)

  • Pre-transplant screening + ivermectin treatment if exposed (Asia, Latin America, sub-Saharan)
  • Hyperinfection mortality 80% if missed

148.3.0.3 3⃣ HBV / HCV Management

  • HBV reactivation prevention: entecavir / tenofovir for HBcAb+ recipient
  • HCV cure pre-transplant (DAAs) or use HCV+ donor (with DAA Tx post-tx — modern protocols)
  • Direct-acting antivirals (DAAs) revolutionized HCV transplant outcomes

148.3.0.4 4⃣ 台灣 context

  • 䞻芁移怍䞭心: 台倧, 林口長庚, 高雄長庚, 䞭國附醫
  • HBV endemic: HBV reactivation 高譊芺
  • TB endemic: pre-transplant IGRA / TST + LTBI 治療 (INH × 9 mo or rifampin × 4 mo)
  • 健保 valganciclovir, ganciclovir, letermovir 絊付 transplant patients
  • Donor screening comprehensive: HIV, HCV, HBV, HTLV, syphilis, CMV, EBV