Cytomegalovirus Disease in Renal Allograft Recipients: A Prospective Study of the Clinical Features, Risk Factors and Impact on Renal Transplantation
Cytomegalovirus Disease in Renal Allograft Recipients: A Prospective Study of the Clinical Features, Risk Factors and Impact on Renal Transplantation
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同种异体肾移植受者的巨细胞病毒病：临床特征、危险因素及其对肾移植影响的前瞻性研究
作者：
P. Peterson;H. Balfour;S. Marker;D. Fryd;R. Howard;R. Simmons
1977年10月1日至1978年11月15日期间，明尼苏达大学健康科学中心治疗了59名患有明显CMV疾病的肾移植受者。在一组141名连续移植患者中，明显CMV疾病的发生率为31%。 53 名患者 (90%) 在移植后 4 个月内出现 CMV 疾病的临床表现，正是在这段时间内，明显的 CMV 疾病与移植肾切除术和死亡的发生率显着增加相关。发烧是最常见的症状（95% 的患者），并且发现明显的 CMV 疾病是所有住院移植受者发烧的最常见原因。长期发热、弥漫性肺部浸润、胃肠道出血、胰腺炎、移植肾切除术和其他全身感染的发生是用于根据疾病严重程度对患者进行分类的临床特征。发现许多这些特征与明显的 CMV 疾病的诊断显着相关。 12 名患者 (20%) 出现致命的 CMV 疾病，其特征是存在大多数这些特征，6 名患者 (10%) 患有严重疾病，9 名患者 (15%) 患有中等严重程度的疾病，32 名患者 (54%) 患有轻度 CMV 疾病，发烧基本上是他们唯一的临床表现。继发性全身感染的发生是最不祥的，在 12 名致命 CMV 疾病患者中，有 10 名发生在死亡前。在本研究期间，唯一死于严重细菌、真菌或原生动物感染的患者患有明显的 CMV 疾病。肝功能检查异常和白细胞减少很常见，异常程度与巨细胞病毒疾病的严重程度相关。在分析对发生明显 CMV 疾病风险的影响的多个因素中，与肾脏捐献者相关的几个因素（捐献者与受者的关系、HLA 匹配和 CMV 血清学）似乎是最重要的。
Fifty-nine renal transplant recipients with overt CMV disease were treated at the University of Minnesota Health Sciences Center between October 1, 1977 and November 15, 1978. In a group of 141 consecutive transplant patients, the incidence of overt CMV disease was 31%. Fifty-three patients (90%) developed clinical manifestations of CMV disease within 4 months of transplantation, and it was during this time period that overt CMV disease was associated with a significantly increased incidence of transplant nephrectomy and death. Fever was the most common presenting symptom (95% of patients), and overt CMV disease was found to be the single most common cause of fever in all hospitalized transplant recipients. Prolonged fever, diffuse pulmonary infiltrates, gastrointestinal bleeding, pancreatitis, transplant nephrectomy and development of other systemic infections were clinical features used to categorize patients according to disease severity. A number of these features were found to be significantly associated with the diagnosis of overt CMV disease. Twelve patients (20%) developed lethal CMV disease characterized by the presence of most of these features, 6 (10%) had severe disease, 9 (15%) had disease of moderate severity and 32 patients (54%) had mild CMV disease with fever being essentially their only clinical finding. Development of secondary systemic infection was most ominous, and occurred before death in 10 of the 12 patients with lethal CMV disease. The only patients to die with serious bacterial, fungal or protozoan infection during the period of this study had concomitant overt CMV disease. Abnormal liver function tests and leukopenia were common, and the degree of abnormality correlated with the severity of CMV disease. Of the multiple factors analyzed for their influence on the risk of developing overt CMV disease, several factors related to the kidney donor (the relationship of the donor to the recipient, HLA matching and CMV serology) appeared to be most important.