Sagedal Solbjørg, Hartmann Anders, Nordal Knut P, Osnes Kåre, Leivestad Torbjørn, Foss Aksel, Degré Miklos, Fauchald Per, Rollag Halvor
Department of Internal Medicine, Laboratory for Renal Physiology, Institute of Biostatistics, Rikshospitalet University Hospital, Oslo, Norway.
Kidney Int. 2004 Jul;66(1):329-37. doi: 10.1111/j.1523-1755.2004.00735.x.
The impact of cytomegalovirus (CMV) infection and disease on long-term outcome after kidney transplantation is still unsettled.
Between 1994 and 1997, 397 consecutive first kidney graft recipients and 74 retransplants were included in the study and followed prospectively until December 31, 2001. CMV infection (CMV pp65 antigenemia) and CMV disease were recorded once weekly during the first 100 days after transplantation. No CMV prophylaxis or preemptive therapy was given. In a multiple Cox proportional hazard model allowing time-dependent covariates, the effects of asymptomatic CMV infection and CMV disease, recipient age and gender, retransplantation, living donor, panel-reactive cytotoxid antibodies, acute rejection, and graft loss were tested on overall mortality beyond 100 days post-transplantation. In a similar analysis, the effect of asymptomatic CMV infection and CMV disease plus other factors were tested on death censored graft loss beyond 100 days.
Median (range) follow up time was 66.6 (<1-86.9) months. The incidence of CMV infection and disease during the first 100 days was 62.8% and 23.4%, respectively. The number of total deaths was 96 (20%), 82 occurred after the first 100 days. Independent risk factors for overall mortality beyond 100 days were asymptomatic CMV infection, RR = 2.90 (95% CI 1.61-5.22) (P= 0.001), CMV disease, RR = 2.50 (95% CI 1.31-4.79) (P= 0.006), both compared to no infection or disease, recipient age, RR = 1.066 per year (95% CI 1.048-1.084) (P < 0.001), and graft loss in the whole study period RR = 7.88 (95% CI 4.75-13.08) (P < 0.001). Asymptomatic CMV infection and CMV disease were not independent risk factors for death censored graft loss, but they significantly reduced graft survival uncensored for death, (log rank P= 0.001, respectively).
Asymptomatic CMV infection and overt CMV disease during the first 100 days increase the risk of recipient mortality beyond 100 days. This raises the question whether CMV prophylaxis should be given routinely after kidney transplantation.
巨细胞病毒（CMV）感染及疾病对肾移植术后长期预后的影响仍未明确。
1994年至1997年，397例连续的首次肾移植受者和74例再次移植受者纳入本研究，并进行前瞻性随访直至2001年12月31日。移植后前100天内每周记录一次CMV感染（CMV pp65抗原血症）和CMV疾病情况。未给予CMV预防或抢先治疗。在一个允许时间依存性协变量的多因素Cox比例风险模型中，检测无症状CMV感染和CMV疾病、受者年龄和性别、再次移植、活体供者、群体反应性细胞毒性抗体、急性排斥反应及移植肾失功对移植后100天以上总体死亡率的影响。在一项类似分析中，检测无症状CMV感染和CMV疾病加上其他因素对移植后100天以上死亡截尾的移植肾失功的影响。
中位（范围）随访时间为66.6（<1 - 86.9）个月。移植后前100天内CMV感染和疾病的发生率分别为62.8%和23.4%。总死亡人数为96例（20%），其中82例发生在100天之后。移植后100天以上总体死亡的独立危险因素为无症状CMV感染（RR = 2.90，95%可信区间1.61 - 5.22，P = 0.001）、CMV疾病（RR = 2.50，95%可信区间1.31 - 4.79，P = 0.006），二者与无感染或疾病相比，受者年龄（RR =每年1.066；95%可信区间1.048 - 1.084，P < 0.001），以及整个研究期间移植肾失功（RR = 7.88，95%可信区间4.75 - 13.08，P < 0.001）。无症状CMV感染和CMV疾病不是死亡截尾的移植肾失功的独立危险因素，但它们显著降低了未因死亡而截尾的移植肾存活率（对数秩检验P分别为0.001）。
移植后前100天内的无症状CMV感染和显性CMV疾病增加了受者移植后100天以上的死亡风险。这就提出了肾移植术后是否应常规给予CMV预防的问题。
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