The independent role of cytomegalovirus as a risk factor for invasive fungal disease in orthotopic liver transplant recipients
The independent role of cytomegalovirus as a risk factor for invasive fungal disease in orthotopic liver transplant recipients
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DOI：
10.1016/s0002-9343(97)80021-6
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发表时间：
1997-08-01
影响因子：
5.9
通讯作者：
Rubin, RH
中科院分区：
文献类型：
--
作者：
George, MJ;Snydman, DR;Rubin, RH
目的：评估巨细胞病毒(CMV)供受者血清状态、感染或疾病对原位肝移植患者侵袭性真菌感染发生的影响。方法和方法：对来自波士顿4所大学附属移植中心(波士顿肝移植中心)的146名肝移植受者(意向治疗队列)的前瞻性收集数据进行分析。观察患者移植后1年的巨细胞病毒感染、巨细胞病毒病、巨细胞病毒肺炎以及机会性真菌感染、移植物存活率和死亡率。每周取一次尿液、咽喉和每隔一周的巴菲涂层进行巨细胞病毒培养，持续2个月，然后每月6个月，在1年，在任何临床疾病发生时，测量移植前和移植后的变量，包括供者和受者的巨细胞病毒血清状态，无菌体部真菌分离，真菌血症，菌血症，抗生素的使用，免疫抑制，排斥反应的治疗和血液产品的量。结果：生存分析表明，巨细胞病毒病患者在移植后第一年内发生侵袭性真菌病的比例为36%，而非巨细胞病毒病患者的比例为8%(P<；0.0001)。有侵袭性真菌病的患者一年死亡率为15/22(68%)，而无侵袭性真菌病的患者一年死亡率为23/124(19%)(P<；0.001)。多变量、时间依赖分析显示，巨细胞病毒血清阴性的供者器官(P<；0.001)、有菌血症(P=0.001)、移植时联合器官共享网络(UNOS)状态4(需要生命支持措施)(P=0.002)和血小板数量(P=0.002)与侵袭性真菌病独立相关。侵袭性真菌病仅限于发生于移植后2周以上者，与巨细胞病毒病(P=0.003)、菌血症(P=0.003)、生命支持需求(P=0.03)和输血量(P=0.02)有关。(C)1997年，由Excerpta Medica，Inc.
PURPOSE: TO assess impact of cytomegalovirus (CMV) donor-recipient serostatus, infection, or disease on development of invasive fungal infection in orthotopic liver transplant recipients.PATIENTS AND METHODS: An analysis of prospectively collected data in 146 liver transplant recipients (intention to treat cohort) from 4 tertiary care, university-affiliated transplant centers in Boston (Boston Center for Liver Transplantation). Patients were observed for 1 year after transplantation for the development of CMV infection, CMV disease, CMV pneumonia, as well as for the development of opportunistic fungal infections, graft survival, and mortality. Weekly cultures were taken of urine and throat and every other week of buffy coat for CMV for 2 months, then monthly for 6 months, at 1 year, and at the time of any clinical illness, Pre-and posttransplant variables including CMV-serostatus of donor and recipient, fungal isolation from sterile body sites, fungemia, bacteremia, antibiotic use, immunosuppression, treatment for rejection, and volumes of blood products were measured.RESULTS: Survival analysis demonstrated that 36% of patients with CMV disease developed invasive fungal disease within the first year post-transplant compared with 8% of those without CMV disease (P < 0.0001). One-year mortality in patients with invasive fungal disease was 15 of 22 (68%) compared with 23 of 124 (19%) in those without invasive fungal disease (P < 0.001). A multivariable, time-dependent analysis demonstrated that being a CMV-seronegative recipient of a CMV-seropositive donor organ (P < 0.001), having bacteremia (P = 0.001), UNOS (United Network for Organ Sharing) status 4 (need for life support measures) at transplant (P = 0.002), and volume of platelets (P = 0.002) were independently associated with invasive fungal disease. Restriction of cases of invasive fungal disease to those that occurred more than 2 weeks after transplant demonstrated an association with CMV disease (P = 0.003), bacteremia (P = 0.003), need for life support (P = 0.03), and volume of blood products transfused (P = 0.02).CONCLUSION: CMV disease or being a CMV-seronegative recipient of a CMV-seropositive donor organ is an important predictor for invasive fungal disease following orthotopic liver transplantation. (C) 1997 by Excerpta Medica, Inc.