Kidney function of Japanese children undergoing kidney transplant with preemptive therapy for cytomegalovirus infection
Kidney function of Japanese children undergoing kidney transplant with preemptive therapy for cytomegalovirus infection
复制标题
日本巨细胞病毒感染肾移植儿童的肾功能
DOI：
10.1111/tid.13271
复制
发表时间：
2020
影响因子：
2.6
通讯作者：
Honda
中科院分区：
文献类型：
--
作者：
Gotoh Yoshimitsu;Shishido Seiichiro;Hamasaki Yuko;Watarai Yoshihiko;Hattori Motoshi;Miura Kenichiro;Ishizuka Kiyonobu;Fujita Naoya;Saito Kazuhide;Nakagawa Yuki;Hotta Kiyohiko;Hataya Hiroshi;Hamada Riku;Sato Hiroyuki;Kitayama Hirotsugu;Ishikura Kenji;Honda
背景巨细胞病毒（CMV）感染是影响肾移植（KTx）患者发病率和死亡率的主要因素之一。KTx前儿童CMV血清阳性率低于成人；因此，小儿KTx患者感染巨细胞病毒的风险较高。在日本儿科KTx患者中，CMV感染的先发制人治疗是主要的常规治疗方法。这项研究调查了这种先发制人的治疗是否会影响KTx后2年的肾功能。方法共招募163例患者，约占日本儿科KTx患者的一半。我们比较了CMV病毒血症组、CMV疾病组和未感染组在KTx后2年的顺序估计肾小球滤过率（eGFR）和其他影响因素的值。结果KTx术后发生巨细胞病毒感染75例（46.0%），其中38.7%发生巨细胞病毒病。三组间经KTx治疗后的eGFR序列值无显著差异。巨细胞病毒感染与其他因素、其他感染（包括Epstein‐Barr [EB]病毒感染）、急性排斥反应（AR）或不良事件无关。只有总住院时间延长与巨细胞病毒感染显著相关（P= 0.002）。在多变量分析中，年龄较小、巨细胞病毒感染和不良反应与总住院时间延长独立显著相关。结论以病毒血症和疾病为证据的CMV感染的预防性治疗对日本儿童KTx患者术后2年的肾功能无显著影响。
BackgroundCytomegalovirus (CMV) infection is one of the major factors that affect morbidity and mortality in kidney transplant (KTx) patients. The rate of CMV seropositivity in children before KTx is lower than that in adults; therefore, pediatric KTx patients have a higher risk of CMV infection. In Japanese pediatric KTx patients, preemptive therapy for CMV infection is a main conventional therapy. This study investigated whether this preemptive treatment would affect kidney function at 2 years post‐KTx.MethodsA total of 163 patients, that is approximately half of the Japanese pediatric KTx patients nationwide, were recruited to participate in our study. We compared the values of the sequential estimated glomerular filtration rate (eGFR) at two years post‐KTx and other influencing factors in CMV viremia, CMV disease, and no‐infection groups.ResultsCytomegalovirus infection after KTx occurred in 75 patients (46.0%), 38.7% of whom developed CMV disease. The sequential eGFR values post‐KTx did not differ significantly between the three groups. CMV infection was not significantly correlated with other factors, other infections (including Epstein‐Barr [EB] virus infection), acute rejection (AR), or adverse events. Only prolonged duration of total hospitalization was significantly associated with CMV infection (P= .002). In the multivariate analysis, younger age, CMV infection, and adverse effects were independently significantly related to prolonged total hospitalization.ConclusionPreemptive therapy for CMV infection evidenced by viremia and disease did not significantly influence kidney function in Japanese pediatric KTx patients at two years after the operation.