Impact of belatacept and tacrolimus on cytomegalovirus viral load control and relapse in moderate and high-risk cytomegalovirus serostatus kidney transplant recipients.
Impact of belatacept and tacrolimus on cytomegalovirus viral load control and relapse in moderate and high-risk cytomegalovirus serostatus kidney transplant recipients.
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DOI：
10.1111/tid.13983
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发表时间：
2022-12
影响因子：
2.6
通讯作者：
Larsen, Christian P.
中科院分区：
文献类型：
--
作者：
Magua, Wairimu;Johnson, Aileen C.;Karadkhele, Geeta M.;Badell, Idelberto R.;Vasanth, Payaswini;Mehta, Aneesh K.;Easley, Kirk A.;Newell, Kenneth A.;Rickert, Joseph B.;Larsen, Christian P.
关键词：
belataceptclinical researchpracticeCMV bidirectional viral load state transitionsCMV controlCMV high-riskCMV moderate-riskCMV management strategiesCMV relapseCMV serostatus riskCMV viral infection and infectious agentsCMV viral load dynamicsCMV viral load volatilitycytomegalovirusimmunosuppressionimmune modulationimmunosuppressive regimens-maintenanceinfectious diseasekidney (allograft) functiondisfunctionkidney transplantlength of stay in viral load stateMarkov multistatetacrolimusviral load trajectoryviremia
Belatacept可改善移植物的长期存活率，但对某些原发性病毒感染的控制可能受损。我们评估了贝拉西普和他克莫司对巨细胞病毒（CMV）高危和中危受者的病毒控制、缓解和复发的影响。使用多状态马尔可夫模型，我们评估了173例肾移植受者在移植后1年内至少发生一次病毒血症的病毒载量状态转换：状态1，检测不到/低病毒载量;状态2，中度病毒血症;状态3，重度病毒血症。在高风险接受者中，贝拉西普治疗的接受者出现中度病毒血症的概率（0.36; 95%CI = 0.31，0.41）显著高于他克莫司治疗的接受者（0.20; 95%CI = 0.13，0.29）。病毒血症状态的预期天数不同。高风险贝拉西普治疗的受试者持续中度病毒血症的时间显著延长（128天，95% CI = 110，146）（70.0天，95% CI = 45.2，100），并显示低/不可检测病毒载量状态持续时间较短的趋势（172天，95% CI = 148，195）比他克莫司治疗的受体（239天，95% CI = 195，277）。中危受体表现出更好的病毒载量控制，免疫抑制无差异。相对于他克莫司治疗的受者，高风险贝拉西普治疗的受者在维持病毒控制方面存在缺陷。应考虑避免在高风险接受者中首次使用贝拉西普或制定修改的管理方案。
Belatacept improves long‐term graft survival, but control of some primary viral infections may be impaired. We evaluated the impact of belatacept and tacrolimus on cytomegalovirus (CMV) viral control, remission and relapse in CMV high‐risk and moderate‐risk recipients. Using a multistate Markov model, we evaluated viral load state transitions of 173 kidney transplant recipients with at least one episode of viremia within 1 year after transplant: state 1, undetectable/low viral load; state 2, moderate viremia; and state 3, severe viremia. Among high‐risk recipients, belatacept‐treated recipients exhibited a significantly higher probability of entering moderate viremia (.36; 95% CI = .31, .41) than tacrolimus‐treated recipients (.20; 95% CI = .13, .29). The expected number of days in viremic states differed. High‐risk belatacept‐treated recipients persisted in moderate viremia for significantly longer (128 days, 95% CI = 110, 146) than did tacrolimus‐treated recipients (70.0 days, 95% CI = 45.2, 100) and showed a trend of shorter duration in low/undetectable viral load state (172 days, 95% CI = 148, 195) than did tacrolimus‐treated recipients (239 days, 95% CI = 195, 277). Moderate‐risk recipients showed better viral load control and with no differences by immunosuppression. High‐risk belatacept‐treated recipients showed defects in sustaining viral control relative to tacrolimus‐treated recipients. Avoidance of initial use belatacept in high‐risk recipients or development of modified management protocols should be considered.
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影响因子：
6.1
作者：
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通讯作者：
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