Bronchiolitis obliterans syndrome and early human cytomegalovirus DNAaemia dynamics after lung transplantation.
Bronchiolitis obliterans syndrome and early human cytomegalovirus DNAaemia dynamics after lung transplantation.
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DOI：
10.1097/01.tp.0000069234.04901.a3
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发表时间：
2003-06-27
期刊：
影响因子：
6.2
通讯作者：
Kotsimbos, TC
中科院分区：
文献类型：
--
作者：
Westall, GP;Michaelides, A;Kotsimbos, TC
背景资料。闭塞性细支气管炎综合征(BOS)仍然是肺移植术后发病率和死亡率的主要原因。BOS的主要危险因素是急性排斥反应和人类巨细胞病毒(HCMV)感染，后者分别采用了相对不敏感和非特异性的措施，如HCMV肺炎和HCMV血清状态。我们假设，对肺移植受者(LTRS)中的HCMV重新激活进行更准确的前瞻性分析将有助于我们更好地理解HCMV与BOS发生之间的联系。在移植后最初的6个月中，26个LTRS用定量聚合酶链式反应每月检测一次人巨细胞病毒DNA血症。BOS被定义为在没有任何其他原因的情况下，移植后FEV1与最佳基线FEV1相比持续不可逆转地下降20%。在26个LTRs中，有23个可以根据BOS结果变量进行评估。在37个月的中位随访期，有10名患者发展为BOS。在最初的6个月监测期间，23例患者中有15例至少一次检测到HCMV DNA血症，8例患者有12次巨细胞病毒肺炎发作。8例移植后出现A3级或以上急性排斥反应，其中6例至少一次HCMV DNA阳性，4例合并HCMV肺炎。我们的结果显示，早期巨细胞病毒DNA血症的检测与BOS密切相关(单变量分析[P=0.002]和非BOS分析[P=0.006])。尽管常规的更昔洛韦预防措施，LTRS中的早期HCMV DNA血症与BOS的发生有关。
Background. Bronchiolitis obliterans syndrome (BOS) remains a major cause of morbidity and mortality after lung transplantation. The major identified risk factors for BOS are acute rejection and human cytomegalovirus (HCMV) infection, the latter despite the use of relatively insensitive and nonspecific measures such as HCMV pneumonitis and HCMV serostatus, respectively. We hypothesized that a more accurate prospective analysis of HCMV reactivation in lung transplant recipients (LTRs) would improve our understanding of the association between HCMV and BOS development.Methods. In 26 LTRs, HCMV DNAaemia was measured using quantitative polymerase chain reaction at monthly intervals during the initial 6 months post-transplantation. BOS was defined as a sustained irreversible 20% decrease in FEV1 compared with the best baseline FEV1 posttransplantation in the absence of any other cause.Results. Of the 26 LTRs, 23 were assessable with regard to the BOS outcome variable. At a median follow-up of 37 months, 10 patients had developed BOS. During the first 6-month monitoring period, HCMV DNAaemia was detected in 15 of the 23 patients on at least one occasion, and there were 12 episodes of HCMV pneumonitis in eight patients. Episodes of grade A3 or greater acute rejection occurred in eight LTRs, six of whom had been HCMV DNAaemia positive at least once and four of whom also demonstrated HCMV pneumonitis. Our results revealed a strong association between BOS and early HCMV DNAaemia detection (univariate analysis [P=0.002] and freedom from BOS analysis [P=0.006]).Conclusion. Early HCMV DNAaemia in LTRs is associated with the development of BOS despite routine ganciclovir prophylaxis.