Schlischewsky E, Fuehner T, Warnecke G, Welte T, Haverich A, Ganzenmueller T, Heim A, Gottlieb J
Department of Respiratory Medicine, Hannover Medical School, Hannover, Germany.
Transpl Infect Dis. 2013 Feb;15(1):60-9. doi: 10.1111/tid.12015. Epub 2012 Oct 2.
Cytomegalovirus (CMV) is an important pathogen after lung transplant (LTx) and may be associated with bronchiolitis obliterans syndrome (BOS). We assessed the outcome of LTx patients with CMV DNA-positive bronchoalveolar lavage (BAL) during surveillance.
A single-center retrospective study was performed. Outpatients transplanted between September 2007 and February 2010, who had undergone at least 3 BALs, were included. CMV DNA load in BAL was measured by polymerase chain reaction (PCR). Monitoring of peripheral blood antigenemia was performed simultaneously.
In total, 103 LTx patients underwent 1118 BALs. During median follow-up of 639 days (interquartile range, 495-780), 53 (51%) patients exhibited at least 1 positive CMV PCR in BAL. The incidence of positive CMV PCR varied post transplantation, with 6%, 30%, and 25% of BALs testing positive at <6 months, 6-24 months, and >24 months, respectively. Neither CMV BAL positivity, positive CMV antigenemia, nor dual positivity were significantly associated with BOS-free survival during follow-up. Patients with CMV-positive BAL more frequently developed CMV antigenemia in the first year (44% vs. 5%, respectively, log-rank P < 0.001).
Detection of CMV-positive BAL after the sixth month appears common, but did not correlate with BOS-free survival after LTx in this study. An increased risk of developing blood antigenemia was observed in patients with positive CMV PCR in BAL, warranting close follow-up.
巨细胞病毒（CMV）是肺移植（LTx）术后的一种重要病原体，可能与闭塞性细支气管炎综合征（BOS）相关。我们评估了监测期间CMV DNA阳性支气管肺泡灌洗（BAL）的LTx患者的预后。
进行了一项单中心回顾性研究。纳入2007年9月至2010年2月间接受移植且至少进行了3次BAL的门诊患者。通过聚合酶链反应（PCR）测量BAL中的CMV DNA载量。同时进行外周血抗原血症监测。
共有103例LTx患者接受了1118次BAL。在中位随访639天（四分位间距，495 - 780天）期间，53例（51%）患者的BAL中至少有1次CMV PCR呈阳性。CMV PCR阳性的发生率在移植后有所不同，分别有6%、30%和25%的BAL在<6个月、6 - 24个月和>24个月时检测呈阳性。在随访期间，CMV BAL阳性、CMV抗原血症阳性或两者均阳性与无BOS生存均无显著相关性。CMV阳性BAL的患者在第一年更频繁地出现CMV抗原血症（分别为44%和5%，对数秩检验P < 0.001）。
在本研究中，第六个月后检测到CMV阳性BAL似乎很常见，但与LTx后的无BOS生存无关。BAL中CMV PCR阳性的患者发生血液抗原血症的风险增加，需要密切随访。
