Duncan A J, Dummer J S, Paradis I L, Dauber J H, Yousem S A, Zenati M A, Kormos R L, Griffith B P
Department of Cardiothoracic Surgery, Presbyterian Hospital, University of Pittsburgh, Pa 15261.
J Heart Lung Transplant. 1991 Sep-Oct;10(5 Pt 1):638-44; discussion 645-6.
Fifty-nine patients who survived more than 30 days after lung transplantation (52 heart-lung, seven double lung, and two single lung) were studied for mortality and morbidity related to cytomegalovirus (CMV) infection. CMV infection developed in 32 patients (54%) and was more common in the preoperatively CMV seropositive group (95%) as compared with the seronegative group (38%). Symptomatic infections, pneumonitis, and CMV-related mortality, however, were higher in the seronegative (primary infection) group and actuarial survival was worse in these patients (40% and 23% at 1 and 5 years, respectively). Transplantation of CMV-seropositive donor organs was associated with a significantly higher incidence of primary infection and use of seronegative blood products led to a decrease in the primary CMV infection rate. The mortality of primary CMV infection was 54% and this was associated with a significantly higher rate of pulmonary superinfections in the first year after transplantation. The incidence of late pulmonary infections was associated with the development of chronic rejection rather than CMV status. We conclude that primary CMV infection has a major impact on the outcome after lung transplantation. The high mortality of primary infections justifies an aggressive approach to prevention and treatment in the at-risk seronegative group.
对59例肺移植术后存活超过30天的患者（52例心肺联合移植、7例双肺移植和2例单肺移植）进行了与巨细胞病毒（CMV）感染相关的死亡率和发病率研究。32例患者（54%）发生了CMV感染，与血清学阴性组（38%）相比，术前CMV血清学阳性组（95%）的感染更为常见。然而，血清学阴性（原发性感染）组的症状性感染、肺炎和CMV相关死亡率更高，这些患者的精算生存率更差（1年和5年时分别为40%和23%）。移植CMV血清学阳性供体器官与原发性感染的发生率显著升高相关，而使用血清学阴性血液制品可降低原发性CMV感染率。原发性CMV感染的死亡率为54%，这与移植后第一年肺部重叠感染的发生率显著升高相关。晚期肺部感染的发生率与慢性排斥反应的发生有关，而非CMV状态。我们得出结论，原发性CMV感染对肺移植后的结局有重大影响。原发性感染的高死亡率证明对有风险的血清学阴性组采取积极的预防和治疗方法是合理的。
