Impact of Cytomegalovirus on Long-term Mortality and Cancer Risk After Organ Transplantation
Impact of Cytomegalovirus on Long-term Mortality and Cancer Risk After Organ Transplantation
复制标题
DOI：
10.1097/tp.0000000000000641
复制
发表时间：
2015-09-01
期刊：
影响因子：
6.2
通讯作者：
Neuberger, James
中科院分区：
文献类型：
--
作者：
Desai, Rajeev;Collett, Dave;Neuberger, James
背景资料。关于巨细胞病毒(CMV)感染对移植后生存和癌症风险的影响，有相互矛盾的证据。方法：研究方法。所有1987至2007年间在英国接受肾、肝、心和肺移植且已知巨细胞病毒免疫球蛋白G状态的受者都是从英国移植登记中心确认的。受者按供受者CMV状态分为：供者(D)阴性受者(R)阴性(D-R-)、D-R+、D+R+和D+R-。癌症数据是从国家统计局获得的。评估了巨细胞病毒感染对生存率和癌症发病率的影响。结果。D-R受体移植后10年存活率(73.6%[95%CI，72.3，74.9])显著高于其他受体(66.1%[65.3，66.9])(P<；0.0001)。与D-R组相比，D+R-组肾移植后10年内死亡的风险比D-R组高14%(P=0.0495)，肝移植组高13%(P=0.16)，心脏移植组高34%(P=0.01)，肺移植组高35%(P=0.006)。暴露于巨细胞病毒的受者中，有心血管死因的受者比例(18%)高于D-R受者(16%)(P=0.03)。巨细胞病毒状态与癌症风险的增加无关。结论。这项大型研究的结果表明，巨细胞病毒与肾脏和心胸移植受者的长期死亡率显著增加以及心血管死亡风险增加有关，但与移植后癌症无关。
Background. There is conflicting evidence of the effect of cytomegalovirus (CMV) infection on survival and the risk of cancer after transplantation. Methods. All recipients of kidney, liver, heart, and lung transplants in the United Kingdom between 1987 and 2007 with known CMV immunoglobulin G status were identified from the U.K. Transplant Registry. Based on the donor-recipient CMV status, recipients were grouped into: donor (D) negative recipient (R) negative (D-R-), D-R+, D+ R+ and D + R-. Cancer data were obtained from the Office for National Statistics. The impact of CMV infection on survival and cancer incidence was assessed. Results. The 10-year posttransplant survival in D-R-recipients (73.6% [95% CI, 72.3, 74.9]) was significantly higher (P < 0.0001) than in other recipients (66.1% [65.3, 66.9]). Compared with the D-R-group, the risk-adjusted hazard of death within 10 years of transplantation for D+ R-group was 14% higher for kidney recipients (P = 0.0495), 13% higher for liver recipients (P = 0.16), 34% higher for heart recipients (P = 0.01), and 35% higher for lung recipients (P = 0.006). The proportion of recipients with a cardiovascular cause of death was higher (P = 0.03) among the recipients exposed to CMV (18%) as compared to the D-R-recipients (16%). The CMV status was not associated with an increased risk of cancer. Conclusions. The results from this large study demonstrate that CMV is associated with a significantly increased long-term mortality in kidney and cardiothoracic transplant recipients and an increased risk of cardiovascular death but not of posttransplant cancer.