da Cunha-Bang Caspar, Sørensen Søren S, Iversen Martin, Sengeløv Henrik, Hillingsø Jens G, Rasmussen Allan, Mortensen Svend A, Fox Zoe V, Kirkby Nikolai S, Christiansen Claus B, Lundgren Jens D
Copenhagen HIV Programme, University of Copenhagen, Faculty of Health Sciences, The Panum Institute/Building 21.1, Blegdamsvej 3B, 2200 Copenhagen N, Denmark.
Scand J Infect Dis. 2011 May;43(5):360-5. doi: 10.3109/00365548.2010.549836. Epub 2011 Feb 9.
Infection with cytomegalovirus (CMV) remains a potentially serious complication in transplant patients. In this study we explored the risk factors for CMV infection in the 12 months following a solid organ transplantation (n = 242) in patients monitored for CMV infection from 2004 to 2007.
CMV infection was defined as 2 consecutive quantifiable CMV-polymerase chain reaction (PCR) values or 1 measurement of >3000 copies/ml. Data describing pre- and post-transplantation variables were extracted from electronic health records. Time to CMV infection was investigated using Cox proportional hazards analysis.
Overall, 31% (75/242) of solid organ transplant patients developed CMV infection: 4/8 (50.0%) heart, 15/43 (34.9%) liver, 30/89 (33.7%) lung and 26/102 (25.5%) kidney transplant patients. The risk of CMV infection according to donor (D)/recipient (R) CMV serostatus (positive + or negative-) was highest for D+/R-(adjusted hazard ratio 2.6, 95% confidence interval 1.6-4.2) vs D+/R+, and was reduced for D-/R+(adjusted hazard ratio 0.2, 95% confidence interval 0.2-0.8) vs D+/R+.
Positive donor CMV-serostatus is a major risk factor for CMV-infection in CMV-na ve recipients, but also in recipients with positive CMV-serostatus. Conversely, if donor is CMV serostatus is negative, the risk of CMV infection is low, irrespective of recipients CMV-serostatus. These findings suggest poorer immune function towards donor-induced strains of CMV versus recipient own latent strains.
巨细胞病毒（CMV）感染仍是移植患者中一种潜在的严重并发症。在本研究中，我们探讨了2004年至2007年监测CMV感染的患者在实体器官移植后12个月内发生CMV感染的危险因素（n = 242）。
CMV感染定义为连续2次可量化的CMV聚合酶链反应（PCR）值或1次测量值>3000拷贝/ml。从电子健康记录中提取描述移植前后变量的数据。使用Cox比例风险分析研究CMV感染的时间。
总体而言，31%（75/242）的实体器官移植患者发生了CMV感染：心脏移植患者中4/8（50.0%），肝脏移植患者中15/43（34.9%），肺移植患者中30/89（33.7%），肾移植患者中26/102（25.5%）。根据供体（D）/受体（R）CMV血清学状态（阳性+或阴性-），D+/R-（调整后风险比2.6，95%置信区间1.6 - 4.2）与D+/R+相比，CMV感染风险最高，而D-/R+（调整后风险比0.2，95%置信区间0.2 - 0.8）与D+/R+相比风险降低。
供体CMV血清学阳性是CMV血清学阴性受体以及CMV血清学阳性受体发生CMV感染的主要危险因素。相反，如果供体CMV血清学状态为阴性，无论受体CMV血清学状态如何，CMV感染风险都很低。这些发现表明，相对于受体自身的潜伏株，对供体诱导的CMV株的免疫功能较差。
