Institut für Immunologie und Transfusionsmedizin, Ernst-Moritz-Arndt-Universität, Greifswald, Germany.
Transfusion. 2011 Dec;51(12):2620-6. doi: 10.1111/j.1537-2995.2011.03203.x. Epub 2011 Jun 3.
Measures to prevent transfusion-transmitted cytomegalovirus (TT-CMV) infection after hematopoietic stem cell transplantation (HSCT) include transfusion of CMV antibody-negative blood units and/or transfusion of leukoreduced cellular blood products. We assessed the incidence of TT-CMV in CMV-seronegative patients receiving CMV-seronegative HSC transplants, who were transfused with leukoreduced cellular blood products not tested for anti-CMV.
In a prospective observational study between 1999 and 2009, all HSCT patients received leukoreduced cellular blood products not tested for anti-CMV. Patients were screened for CMV serostatus and CMV-negative recipients of CMV-negative transplants were systematically monitored for TT-CMV clinically and by CMV nucleic acid testing. Anti-CMV antibodies (immunoglobulin [Ig]G and IgM) were assessed after three time intervals (Interval 1, study inclusion to Day +30 after HSCT; Interval 2, Day +30-Day +100; Interval 3, after Day +100).
Among 142 patients treated with allogeneic HSCT, 23 CMV-negative donor-patient pairs were identified. These 23 patients received 1847 blood products from 3180 donors. All patients remained negative for CMV DNA and none developed CMV-associated clinical complications. This results in a risk for TT-CMV per donor exposure of 0% (95% confidence interval, 0.0%-0.12%). However, 17 of 23 patients seroconverted for anti-CMV IgG, but none for anti-CMV IgM. CMV IgG seroconverters received significantly more transfusions per week than nonconverters.
The risk of TT-CMV is low in high-risk CMV(neg/neg) HSCT patients transfused with leukoreduced blood products not tested for anti-CMV. The cause of anti-CMV IgG seroconversion is most likely passive antibody transmission by blood products.
预防造血干细胞移植（HSCT）后输血传播巨细胞病毒（TT-CMV）感染的措施包括输注 CMV 抗体阴性的血单位和/或输注白细胞减少的细胞血液制品。我们评估了接受 CMV 阴性 HSC 移植且输注未经 CMV 检测的白细胞减少细胞血液制品的 CMV 血清阴性患者发生 TT-CMV 的发生率。
在 1999 年至 2009 年期间进行的一项前瞻性观察研究中，所有 HSCT 患者均接受了未经 CMV 检测的白细胞减少细胞血液制品。患者接受 CMV 血清学检测，CMV 阴性移植的 CMV 阴性受者接受临床和 CMV 核酸检测的 TT-CMV 系统监测。在三个时间间隔（间隔 1，研究纳入至 HSCT 后第 30 天；间隔 2，第 30 天-第 100 天；间隔 3，第 100 天之后）评估抗 CMV 抗体（免疫球蛋白[Ig]G 和 IgM）。
在接受异基因 HSCT 的 142 名患者中，确定了 23 例 CMV 阴性供受者配对。这 23 名患者从 3180 名供者处接受了 1847 个血液制品。所有患者的 CMV DNA 均为阴性，且均未发生与 CMV 相关的临床并发症。这导致每个供者暴露的 TT-CMV 风险为 0%（95%置信区间，0.0%-0.12%）。然而，23 例患者中有 17 例抗 CMV IgG 血清转化，但无抗 CMV IgM 血清转化。CMV IgG 血清转化者每周接受的输血量明显多于未转化者。
在输注未经 CMV 检测的白细胞减少血液制品的高危 CMV（neg/neg）HSCT 患者中，TT-CMV 的风险较低。抗 CMV IgG 血清转化的原因很可能是血液制品被动抗体传播。
