Department of Medicine, Duke University Medical Center, Durham, NC 27710, USA.
Am J Respir Crit Care Med. 2010 Jun 15;181(12):1391-6. doi: 10.1164/rccm.200911-1786OC. Epub 2010 Feb 18.
Cytomegalovirus pneumonitis is one of the most prevalent opportunistic infections after lung transplantation. Early studies reported that cytomegalovirus pneumonitis was a risk factor for chronic allograft dysfunction. More recently, in the era of routine prophylaxis and ganciclovir treatment, the adverse impact of treated cytomegalovirus pneumonitis on bronchiolitis obliterans syndrome has been challenged.
We hypothesized that cytomegalovirus pneumonitis contributes to adverse outcomes in the current antiviral era. We sought to define the impact of treated cytomegalovirus pneumonitis on bronchiolitis obliterans syndrome and survival in a large single-center cohort (n = 231) of consecutive patients undergoing lung transplantation from 2000 to 2004, all receiving short-course ganciclovir prophylaxis.
Transbronchial biopsies were performed at defined intervals with prospective cytomegalovirus immunostaining on every biopsy (n = 1,887). Cox proportional hazards models were used to assess the relationship between treated cytomegalovirus pneumonitis and clinical outcomes.
Forty-nine (21%) recipients developed cytomegalovirus pneumonitis a median of 106 days after transplantation. Treated cytomegalovirus pneumonitis within the first 6 months after transplantation significantly increased the risk for bronchiolitis obliterans syndrome (P = 0.001; hazard ratio, 2.19; 95% confidence interval, 1.36-3.51) and post-transplantation death (P = 0.02; hazard ratio, 1.89; 95% confidence interval, 1.11-3.23). This risk persisted when cytomegalovirus pneumonitis was considered as a time-dependent predictor as well as in multivariable models controlling for other risk factors.
Cytomegalovirus pneumonitis affects more than 20% of lung transplant recipients. Despite treatment, it increases the risk for bronchiolitis obliterans syndrome and death. More effective preventive strategies for cytomegalovirus pneumonitis are needed to improve long-term outcomes after lung transplantation.
巨细胞病毒肺炎是肺移植后最常见的机会性感染之一。早期研究报告称，巨细胞病毒肺炎是慢性移植物功能障碍的危险因素。最近，在常规预防和更昔洛韦治疗的时代，经治疗的巨细胞病毒肺炎对闭塞性细支气管炎综合征的不良影响受到了挑战。
我们假设巨细胞病毒肺炎在当前抗病毒时代对不良结局有影响。我们旨在确定在一个大型单中心队列（n=231）中，经治疗的巨细胞病毒肺炎对闭塞性细支气管炎综合征和生存的影响，该队列由 2000 年至 2004 年间连续接受肺移植的患者组成，所有患者均接受短疗程更昔洛韦预防。
在每个活检时进行经支气管活检，并进行前瞻性巨细胞病毒免疫染色（n=1887），在定义的间隔内进行。使用 Cox 比例风险模型评估经治疗的巨细胞病毒肺炎与临床结局之间的关系。
49 名（21%）受者在移植后中位数 106 天发生巨细胞病毒肺炎。移植后 6 个月内经治疗的巨细胞病毒肺炎显著增加了闭塞性细支气管炎综合征的风险（P=0.001；风险比，2.19；95%置信区间，1.36-3.51）和移植后死亡（P=0.02；风险比，1.89；95%置信区间，1.11-3.23）。当将巨细胞病毒肺炎视为时间依赖性预测因子以及在多变量模型中控制其他危险因素时，这种风险仍然存在。
巨细胞病毒肺炎影响超过 20%的肺移植受者。尽管进行了治疗，但它会增加闭塞性细支气管炎综合征和死亡的风险。需要更有效的巨细胞病毒肺炎预防策略，以改善肺移植后的长期结局。
