Kim J M, Kim S J, Joh J-W, Kwon C H D, Shin M, Kim E Y, Moon J I, Jung G O, Choi G S, Lee S K
Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
Transplant Proc. 2010 Apr;42(3):884-9. doi: 10.1016/j.transproceed.2010.02.025.
The delayed onset of cytomegalovirus (CMV) infection after liver transplantation can place patients at risk for graft failure and mortality.
We compared early versus delayed onset of CMV infection to identify risk factors for mortality among liver transplant recipients in an endemic area.
Among 710 consecutive adult liver transplant recipients, incidence of CMV infection was 47.5% (337/710). Male gender, biliary complications, acute rejection episodes, antilymphocyte antibodies high hemoglobin, and high total bilirubin were significantly different among patients with delayed versus early onset CMV infections. The overall incidence of early versus delayed CMV infections was 43.1% (306/710) versus 4.4% (31/710). Among them, 11.1% (34/306) and 25.8% (8/31) of patients developed CMV disease.
These results showed that a higher proportion of patients developed disease among delayed CMV infected patients (P=.039). The overall and graft survival curves for patients with early onset CMV infections were better than those of patients who had delayed onset CMV infections (P=.026 and P=.014). Recurrence of hepatitis B virus, hepatic dysfunction, and retransplantation were associated with increased mortality among patients who had a delayed CMV infection.
肝移植后巨细胞病毒（CMV）感染的延迟发作会使患者面临移植物衰竭和死亡的风险。
我们比较了CMV感染的早期发作与延迟发作，以确定流行地区肝移植受者的死亡风险因素。
在710例连续的成年肝移植受者中，CMV感染的发生率为47.5%（337/710）。CMV感染延迟发作与早期发作的患者在性别、胆道并发症、急性排斥反应、抗淋巴细胞抗体、高血红蛋白和高总胆红素方面存在显著差异。早期与延迟CMV感染的总体发生率分别为43.1%（306/710）和4.4%（31/710）。其中，分别有11.1%（34/306）和25.8%（8/31）的患者发生了CMV疾病。
这些结果表明，延迟CMV感染的患者中发生疾病的比例更高（P = 0.039）。早期发作CMV感染患者的总体和移植物生存曲线优于延迟发作CMV感染的患者（P = 0.026和P = 0.014）。乙型肝炎病毒复发、肝功能障碍和再次移植与延迟CMV感染患者的死亡率增加有关。
