Patient years lost due to cytomegalovirus serostatus mismatching in the scientific registry of transplant recipients.
Patient years lost due to cytomegalovirus serostatus mismatching in the scientific registry of transplant recipients.
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DOI：
10.3389/fimmu.2023.1292648
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发表时间：
2023
影响因子：
7.3
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中科院分区：
文献类型：
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在美国，死亡供体肾移植（DDKT）受者的巨细胞病毒（CMV）错配率仍高于40%。由于CMV错配在DDKT受者中很常见，累积效应在总体患者和移植物存活的背景下可能是显著的。我们的主要目的是描述DDKT受者中高风险CMV供体阳性/受体阴性（D+/R-）错配相关的短期和长期风险，明确目标是推导数学错配惩罚。我们使用2011-2022年之间移植的供体匹配DDKT受体对（N= 105，608）对移植受体科学登记（SRTR）数据库进行了回顾性二次分析。全因死亡率和移植失败的风险比计算从一年到十年后DDKT。全因移植失败包括死亡事件。使用Kaplan-Meier估计法计算DDKT后10年的生存曲线，并外推至20年，以提供由于CMV D+/R-血清状态不匹配导致的平均移植物损失天数（aGDL）和平均患者损失天数（aPDL）。我们还进行了基于年龄的分层分析，以比较不同年龄组CMV D+错配的相对风险。在31,518例CMV D+/R-受体中，DDKT后1年，与匹配的CMV D+/R+组（N=31,518）相比，死亡的相对风险增加了29%（p <0.001），移植失败增加了17%（p<0.001）。年龄分层显示，40岁及以上患者CMV错配相关风险显著增加。由于错配，每例患者的aGDL为125天，每例患者的aPDL为100天。CMV D+/R-错配的风险在DDKT后1年出现，并在患者的整个生命周期中累积，平均CMV D+/R-受体在DDKT后失去超过3个月的生存时间。CMV D+/R-错配比以前报道的风险更大，健康负担更大，因此无需更好的预防策略，包括CMV血清导向的器官分配，以延长高危患者的寿命和移植物存活。
The cytomegalovirus (CMV) mismatch rate in deceased donor kidney transplant (DDKT) recipients in the US remains above 40%. Since CMV mismatching is common in DDKT recipients, the cumulative effects may be significant in the context of overall patient and graft survival. Our primary objective was to describe the short- and long-term risks associated with high-risk CMV donor positive/recipient negative (D+/R-) mismatching among DDKT recipients with the explicit goal of deriving a mathematical mismatching penalty. We conducted a retrospective, secondary analysis of the Scientific Registry of Transplant Recipients (SRTR) database using donor-matched DDKT recipient pairs (N=105,608) transplanted between 2011-2022. All-cause mortality and graft failure hazard ratios were calculated from one year to ten years post-DDKT. All-cause graft failure included death events. Survival curves were calculated using the Kaplan-Meier estimation at 10 years post-DDKT and extrapolated to 20 years to provide the average graft days lost (aGDL) and average patient days lost (aPDL) due to CMV D+/R- serostatus mismatching. We also performed an age-based stratification analysis to compare the relative risk of CMV D+ mismatching by age. Among 31,518 CMV D+/R- recipients, at 1 year post-DDKT, the relative risk of death increased by 29% (p<0.001), and graft failure increased by 17% (p<0.001) as compared to matched CMV D+/R+ group (N=31,518). Age stratification demonstrated a significant increase in the risk associated with CMV mismatching in patients 40 years of age and greater. The aGDL per patient due to mismatching was 125 days and the aPDL per patient was 100 days. The risks of CMV D+/R- mismatching are seen both at 1 year post-DDKT period and accumulated throughout the lifespan of the patient, with the average CMV D+/R- recipient losing more than three months of post-DDKT survival time. CMV D+/R- mismatching poses a more significant risk and a greater health burden than previously reported, thus obviating the need for better preventive strategies including CMV serodirected organ allocation to prolong lifespans and graft survival in high-risk patients.