Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia 30322-1062, USA.
J Heart Lung Transplant. 2009 Dec;28(12):1299-305. doi: 10.1016/j.healun.2009.07.011. Epub 2009 Sep 26.
Cytomegalovirus (CMV) infection has been implicated in a number of complications after heart transplantation. A recent study suggested that children with positive CMV serology (CMV(+)) before transplantation are at increased risk of developing coronary allograft vasculopathy (CAV) and death when compared with CMV(-) recipients. We analyzed data from the Pediatric Heart Transplant Study Group to determine the impact of recipient CMV status and CMV mismatching on outcome. In addition, the use and efficacy of CMV prophylaxis were studied.
Subjects <18 years of age who underwent heart transplantation during the period from 1993 to 2007 were analyzed. Those transplants in which either the recipient or donor were <6 months of age were excluded due to the confounding effects of maternal antibody. The primary outcome variable was freedom from CAV (mild or greater). Secondary outcomes included freedom from death and freedom from clinical CMV infection. Risk factors were assessed using parametric hazard regression.
Of the 1,598 subjects included in the analysis, 637 (40%) were CMV(+) at the time of transplantation. Some form of CMV prophylaxis was administered to 67% of all recipients, most commonly with a CMV mismatch (donor CMV(+)/recipient CMV(-)). Freedom from clinical CMV infection at 5 years was 91%. Pre-transplant CMV serology was not associated with mortality (p = 0.40) or risk of developing CAV (p = 0.10). CMV mismatch was associated with increased risk of clinical CMV disease (p < 0.001). The use of CMV prophylaxis had no association with mortality or development of CAV. There was also no significant association between CMV prophylaxis and the development of clinical CMV infection.
CMV(+) serology at time of pediatric heart transplantation had no demonstrable association with death or development of CAV. CMV(-) recipients who receive a CMV(+) organ are at increased risk of clinical CMV disease. CMV prophylaxis was commonly used, although further studies are needed to establish an optimal approach for prevention of CMV disease in this population.
巨细胞病毒（CMV）感染与心脏移植后出现的多种并发症有关。最近的一项研究表明，与 CMV（-）受者相比，移植前 CMV 血清学阳性（CMV(+)）的儿童发生冠状动脉移植血管病（CAV）和死亡的风险增加。我们分析了小儿心脏移植研究组的数据，以确定受者 CMV 状态和 CMV 错配对结果的影响。此外，还研究了 CMV 预防的使用和效果。
分析了 1993 年至 2007 年期间接受心脏移植的年龄<18 岁的患者。由于母体抗体的混杂作用，排除了受体或供体年龄<6 个月的移植患者。主要结局变量是无 CAV（轻度或更严重）。次要结局包括无死亡和无临床 CMV 感染。使用参数风险回归评估危险因素。
在纳入分析的 1598 例患者中，637 例（40%）在移植时为 CMV(+)。67%的患者接受了某种形式的 CMV 预防，最常见的是 CMV 错配（供体 CMV(+)/受体 CMV(-)）。5 年时无临床 CMV 感染的比例为 91%。移植前 CMV 血清学与死亡率（p = 0.40）或发生 CAV 的风险（p = 0.10）无关。CMV 错配与临床 CMV 疾病风险增加相关（p<0.001）。CMV 预防的使用与死亡率或 CAV 的发生无关。CMV 预防与临床 CMV 感染的发生也无显著相关性。
儿童心脏移植时 CMV(+)血清学与死亡或 CAV 发展无明显关联。接受 CMV(+)器官的 CMV（-）受者发生临床 CMV 疾病的风险增加。CMV 预防广泛使用，但仍需要进一步研究确定该人群中预防 CMV 疾病的最佳方法。
