肾移植后巨细胞病毒感染：危险因素研究

Post-renal transplant cytomegalovirus infection: study of risk factors.

作者信息

Kute V B, Vanikar A V, Shah P R, Gumber M R, Patel H V, Godara S M, Munjappa B C, Sainaresh V V, Engineer D P, Jain S H, Modi P R, Shah V R, Trivedi V B, Trivedi H L

机构信息

Department of Nephrology and Clinical Transplantation, Institute of Kidney Diseases and Research Center, Dr HL Trivedi Institute of Transplantation Sciences, Ahmedabad, India.

出版信息

Transplant Proc. 2012 Apr;44(3):706-9. doi: 10.1016/j.transproceed.2011.12.025.

DOI:10.1016/j.transproceed.2011.12.025

PMID:22483473

Abstract

OBJECTIVES

Cytomegalovirus (CMV) is a common opportunistic infection following renal transplantation (RTx). It responds promptly to antiviral treatment. The mortality rate reaches 90% if untreated. Identification of risk factors helps in the early diagnosis of CMV. We studied demographic features, risk factors, and outcomes associated with CMV infection in RTx recipients despite ganciclovir prophylaxis.

MATERIALS AND METHODS

We reviewed 720 RTx recipients between 2007 and 2009. We examined the serostatus of the donor and recipient before transplantation using an enzyme-linked immunosorbent assay, and diagnosed CMV infections in recipients by CMV DNA detection with a polymerase chain reaction.

RESULTS

A total of 42 of 750 (5.6%) patients were identified to display CMV infection (69.1%) or disease (30.9%). Their mean age was 34 ± 13.5 years, with 80.9% men. CMV serologic status was D+/R- in 21.4% and D+/R+ in 59.5% patients. Fever, malaise (76.2%), and leukopenia (52.3%) were the commonest presenting symptoms; diabetes (30.9%) and hepatitis C virus (28.6%) the commonest comorbid conditions. Risk factors were triple drug immunosuppression (47.6%), antithymocyte globulin ATG induction (54.8%), and a rejection episode (26.1%) and methylprednisolone (76.2%) which were more common in CMV disease than infection. Mean CMV DNA at diagnosis was 78,803; 71.2% patients developed CMV within 6 months posttransplantation, the majority occurring after 3 months. With a mean follow-up of 4 ± 1.9 years, patient and graft survival rates were 85.7% and 81% with a mean serum creatinine value of 1.83 ± 12 mg/dL.

CONCLUSIONS

Universal CMV prophylaxis was associated with a low incidence (5.6%) and mild form of CMV disease among our patients.

摘要

目的

巨细胞病毒（CMV）是肾移植（RTx）后常见的机会性感染。它对抗病毒治疗反应迅速。若不治疗，死亡率可达90%。识别危险因素有助于CMV的早期诊断。我们研究了接受更昔洛韦预防的RTx受者中与CMV感染相关的人口统计学特征、危险因素及结局。

材料与方法

我们回顾了2007年至2009年间的720例RTx受者。移植前使用酶联免疫吸附测定法检测供体和受者的血清状态，并通过聚合酶链反应检测CMV DNA来诊断受者的CMV感染。

结果

750例患者中共有42例（5.6%）被确定发生CMV感染（69.1%）或疾病（30.9%）。他们的平均年龄为34±13.5岁，男性占80.9%。21.4%的患者CMV血清学状态为供体阳性/受体阴性，59.5%为供体阳性/受体阳性。发热、不适（76.2%）和白细胞减少（52.3%）是最常见的症状；糖尿病（30.9%）和丙型肝炎病毒（28.6%）是最常见的合并症。危险因素包括三联药物免疫抑制（47.6%）、抗胸腺细胞球蛋白（ATG）诱导（54.8%）、排斥反应（26.1%）以及甲泼尼龙（76.2%），这些在CMV疾病中比在感染中更常见。诊断时CMV DNA的平均值为78,803；71.2%的患者在移植后6个月内发生CMV感染，大多数发生在3个月后。平均随访4±1.9年，患者和移植物存活率分别为85.7%和81%，平均血清肌酐值为1.83±1.2mg/dL。