Luan F L, Samaniego M, Kommareddi M, Park J M, Ojo A O
Department of Internal Medicine, Division of Nephrology, University of Michigan, Ann Arbor, Michigan, USA.
Transpl Infect Dis. 2010 Dec;12(6):473-9. doi: 10.1111/j.1399-3062.2010.00532.x.
Late occurrence of cytomegalovirus (CMV) infection remains a concern in CMV-seronegative kidney and/or pancreas transplant recipients of CMV-seropositive organs (donor positive/recipient negative, D+/R-) despite the use of prophylaxis. We investigated the impact of various antibody induction regimens on CMV infection in this group of patients.
A total of 254 consecutive D+/R- kidney and/or pancreas transplant patients were studied. The induction agents rabbit anti-thymocyte globulin (rATG) or basiliximab were used according to the center practice. All patients received prophylaxis with valganciclovir (VGCV) for either 3 or 6 months. The occurrence of CMV infection was confirmed by positive DNA viremia. Multivariate Cox regression analyses were performed to determine risk factors for CMV infection.
The cumulative incidence of CMV infection was 58, 112, and 59 cases per 1000 patient-years for patients who received no antibody induction, induction with rATG, or basiliximab induction, respectively (P=0.02). The use of rATG but not basiliximab was associated with an increased risk for CMV infection (adjusted hazard ratio [AHR] 2.13, 95% confidence interval [CI] 1.24-3.54, P=0.006). Acute rejection and its treatment with rATG were not associated with an increased risk for CMV infection when an additional course of VGCV was given following the treatment. Longer duration of prophylaxis was associated with a reduced risk for CMV infection (AHR 0.54, 95% CI 0.33-0.87, P=0.011).
Induction with rATG is associated with increased risk of CMV infection. Longer duration of prophylaxis is beneficial.
尽管采用了预防措施，但在接受巨细胞病毒（CMV）血清反应阳性器官（供体阳性/受体阴性，D+/R-）的CMV血清反应阴性的肾和/或胰腺移植受者中，CMV感染的晚期发生仍然是一个问题。我们研究了各种抗体诱导方案对该组患者CMV感染的影响。
共研究了254例连续的D+/R-肾和/或胰腺移植患者。根据中心的实践使用诱导剂兔抗胸腺细胞球蛋白（rATG）或巴利昔单抗。所有患者接受缬更昔洛韦（VGCV）预防3或6个月。通过DNA病毒血症阳性确诊CMV感染。进行多变量Cox回归分析以确定CMV感染的危险因素。
未接受抗体诱导、接受rATG诱导或接受巴利昔单抗诱导的患者，CMV感染的累积发病率分别为每1000患者年58、112和59例（P = 0.02）。使用rATG而非巴利昔单抗与CMV感染风险增加相关（调整后的风险比[AHR] 2.13，95%置信区间[CI] 1.24 - 3.54，P = 0.006）。当在治疗后给予额外疗程的VGCV时，急性排斥反应及其用rATG治疗与CMV感染风险增加无关。更长的预防持续时间与CMV感染风险降低相关（AHR 0.54，95% CI 0.33 - 0.87，P = 0.011）。
rATG诱导与CMV感染风险增加相关。更长的预防持续时间有益。
