Impact of valganciclovir prophylaxis duration on cytomegalovirus disease in high-risk donor seropositive/recipient seronegative heart transplant recipients.
Impact of valganciclovir prophylaxis duration on cytomegalovirus disease in high-risk donor seropositive/recipient seronegative heart transplant recipients.
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DOI：
10.1111/tid.13255
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发表时间：
2020-06
期刊：
影响因子：
--
通讯作者：
Limaye AP
中科院分区：
文献类型：
--
作者：
Imlay H;Dumitriu Carcoana AO;Fisher CE;Wong B;Rakita RM;Fishbein DP;Limaye AP
很少有数据支持当前指南建议的6个月以上3个月的抗病毒预防，用于供体血清阳性/受体血清阴性（D+R-）心脏移植受者（HTR）的巨细胞病毒（CMV）疾病预防。我们回顾性评估了2005年7月5日至2016年12月30日在一家中心进行的310例成人HTR的CMV疾病和临床结局。血清学反应阳性（R+）的受者给予缬更昔洛韦（VGCV）预防3个月，D+R-组给予3 ~ 6个月。多变量logistic模型评估CMV疾病的危险因素，使用逆概率加权校正混杂因素。在D+ R-HTR中进行巢式匹配队列研究，以评估CMV疾病相关的发病率。卡方检验和Mann-Whitney检验比较了分类变量和连续变量，p < 0.05被认为是显著的。CMV疾病在所有、D+R-和R+组中的发生率分别为8.7%（27/310）、26.5%（22/83）和2.8%（5/180），包括22.2%（6/27）的综合征和77.8%（21/27）的终末器官受累。在多变量模型中，当作为连续变量（p=0.28）或分类变量（3个月vs 6个月）（p=0.19）进行评估时，较长的预防持续时间与CMV疾病风险降低无关。D+R- HTR中CMV疾病与匹配的D+R-对照组相比，住院率更高（87.5% [14/16] vs 6.3% [1/16]，p<0.001），持续时间更长（中位数4天[IQR 3 - 7] vs中位数0天[IQR 0 - 0]，p=0.001）。CMV疾病仍然是D+ R-HTR发病的主要原因。与D+R-肺和肾接受者中记录的获益相反，VGCV持续时间超过3个月与D+ R-HTR中CMV疾病的发生率较低无关，因此不应常规用于这种情况。
Few data support current guideline recommendations for 6 months over 3 months of antiviral prophylaxis for cytomegalovirus (CMV) disease prevention in donor seropositive/recipient seronegative (D+R-) heart transplant recipients (HTR). We retrospectively assessed CMV disease and clinical outcomes in 310 adult HTR between 7/5/2005 – 12/30/2016 at a single center. Valganciclovir (VGCV) prophylaxis was given for 3 months in recipient seropositive (R+) and for 3 to 6 months in D+R- groups. A multivariable logistic model evaluated risk factors for CMV disease, with use of inverse probability weighting to correct for confounding. A nested matched cohort study within D+R- HTR was performed to assess CMV disease-associated morbidity. Chi-square and Mann-Whitney tests compared categorical and continuous variables, with p < 0.05 considered significant. The incidence of CMV disease among all, D+R-, and R+ groups was 8.7% (27/310), 26.5% (22/83), and 2.8% (5/180), respectively, and included syndrome in 22.2% (6/27) and end-organ involvement in 77.8% (21/27). In multivariable models, longer prophylaxis duration was not associated with reduced risk for CMV disease when assessed either as a continuous (p=0.28) or categorical (3 vs 6 months) variable (p=0.19). CMV disease in D+R- HTR was associated with higher rates of hospitalization (87.5% [14/16] vs 6.3% [1/16], p<0.001) and for a longer duration (median 4 days [IQR 3 – 7] vs median 0 days [IQR 0 – 0], p=0.001) than in matched D+R- controls. CMV disease remains a major cause of morbidity in D+R- HTR. In contrast to documented benefit in D+R- lung and kidney recipients, VGCV duration longer than 3 months was not associated with a lower incidence of CMV disease in D+R- HTR, and should not routinely be used in this setting.
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