High risk of cytomegalovirus infection following solid organ transplantation despite prophylactic therapy
High risk of cytomegalovirus infection following solid organ transplantation despite prophylactic therapy
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DOI：
10.1002/jmv.23539
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发表时间：
2013-05-01
影响因子：
12.7
通讯作者：
Johannessen, Ingolfur
中科院分区：
文献类型：
--
作者：
Harvala, Heli;Stewart, Camilla;Johannessen, Ingolfur
实体器官移植受者的巨细胞病毒感染是一个主要的临床问题。本研究的目的是评估2006年1月至2009年4月间在爱丁堡皇家医院进行的大型实体器官移植队列中，CMV感染的发生率及其与移植后第一年死亡率的相关性。使用医院数据库和患者记录回顾性收集所有可检测到CMV病毒血症的移植患者的数据，包括CMV预防的使用、CMV疾病的性质、治疗和死亡日期（如适用）。比较了肾移植和肝移植受者在四种CMV供体/受者血清状态类别（D+R+，DR，D+R，DR+）中的结局。共纳入428人。尽管给予了缬更昔洛韦预防，但D+ R组31.3%的肝脏和19.2%的肾脏受者在移植后一年内诊断出CMV疾病（综合征或终末器官受累）。所有接受CMV预防的D+R移植受者均出现迟发性CMV疾病。此外，D+R+-组中肾移植受者的CMV疾病发生率明显高于肝移植受者（22% vs. 5%）。CMV感染的D+R+肝、肾移植受者死亡率最高。在接受CMV预防的D+R移植受者中迟发性CMV疾病的高发病率表明，CMV疾病仍然是器官移植后的一个重要问题。此外，D+R+移植患者CMV病毒血症的死亡率惊人的高，突出了对该组进行主动监测的必要性。医学病毒学杂志85：893898，2013. (c)2013 Wiley Periodicals，Inc.
Cytomegalovirus infection (CMV) in solid organ transplant recipients is a major clinical problem. The aim of this study was to evaluate the incidence of CMV infection and its association with mortality during the first year after transplantation in a large solid organ transplant cohort at the Royal Infirmary of Edinburgh between January 2006 and April 2009. Data including the use of CMV prophylaxis, nature of CMV disease, treatment and deceased date (when appropriate) was collected retrospectively using hospital databases and patient notes for all transplanted patients with detectable CMV viraemia. The outcomes between recipients of kidney and liver transplants in the four CMV donor/recipient serostatus categories (D+R+, DR, D+R, DR+) were compared. A total of 428 individuals were included. Despite the administration of valganciclovir prophylaxis, CMV disease (syndrome or end-organ involvement) was diagnosed within the year of transplantation in the D+R-group in 31.3% of liver and 19.2% of kidney recipients. All D+R transplant recipients that received CMV-prophylaxis presented with late-onset CMV disease. Furthermore, the rate of CMV disease in the D+R+-group was markedly higher in renal graft recipients compared to liver recipients (22% vs. 5%). The highest mortality was observed among the D+R+ liver and kidney graft recipients with CMV infection. The high incidence of late-onset CMV disease in D+R transplant recipients receiving CMV prophylaxis demonstrates that CMV disease remains an important problem after organ transplantation. Furthermore, the surprisingly high mortality in the D+R+-transplant patients with CMV viraemia highlights the need for proactive monitoring of this group. J. Med. Virol. 85:893898, 2013. (c) 2013 Wiley Periodicals, Inc.