Mendez-Eirin E, Paniagua-Martín M J, Marzoa-Rivas R, Barge-Caballero E, Grille-Cancela Z, Cañizares A, Naya-Leira C, Gargallo-Fernández P, Castro-Beiras A, Crespo-Leiro M
Advanced Heart Failure and Heart Transplant Unit, Hospital Universitario A Coruña, A Coruña, Spain.
Transplant Proc. 2012 Nov;44(9):2660-2. doi: 10.1016/j.transproceed.2012.09.035.
Infection by cytomegalovirus (CMV) is a major concern in solid organ transplant (SOT). It increases morbidity and mortality. The prevalence of CMV asymptomatic infection and disease is variable among centers, partially related to immunosuppressive protocols and therapeutic strategies to treat CMV. Induction therapy with basiliximab is associated with fewer CMV infections than therapy with OKT3. In our center, universal prophylaxis is used in the first month post-heart transplant (HT) and preemptive therapy (PET) is used later, according to viral load monitoring.
To analyze the short- and long-term incidence of CMV infection and disease post-HT according to CMV status of recipient (R)/donor (D) in a cohort of patients who received induction therapy with basiliximab.
Retrospective analysis of 201 consecutive patients over 18 years of age who underwent HT between February 2001 (when induction therapy with basiliximab was initiated) and June 2011. Patients were divided in two risk subgroups of developing CMV disease: high-risk (D+/R- or D-/R- who received blood transfusions or R-, or donor with unknown serostatus) and low-risk (any other combination).
Of 201 patients (mean age 53.81 ± 11.61 years, 81.1% men). 165 patients were classified in the low-risk and 36 in the high-risk group. The cumulative incidence of asymptomatic CMV infection during the first year post-HT was 47%: 46% in the low-risk and 50% in the high-risk group (P = .668). The incidence of CMV disease during the first year post-HT was 7.5%: 3.6% in the low-risk versus 25% in the high-risk group (P < .001).
In our series, asymptomatic CMV infection after HT is frequent, affecting almost 50% of patients. However, the incidence of CMV disease is very low (7.5%), which confirms the effectiveness of PET. The higher incidence of disease in the high-risk group recommends closer monitoring of viral load in these patients or performing more prolonged universal prophylaxis.
巨细胞病毒（CMV）感染是实体器官移植（SOT）中的一个主要问题。它会增加发病率和死亡率。CMV无症状感染和疾病的患病率在不同中心有所差异，部分与免疫抑制方案和治疗CMV的策略有关。与使用OKT3治疗相比，使用巴利昔单抗进行诱导治疗与较少的CMV感染相关。在我们中心，心脏移植（HT）后第一个月采用普遍预防措施，之后根据病毒载量监测采用抢先治疗（PET）。
分析在接受巴利昔单抗诱导治疗的一组患者中，根据受者（R）/供者（D）的CMV状态，HT后CMV感染和疾病的短期和长期发生率。
对2001年2月（开始使用巴利昔单抗诱导治疗时）至2011年6月期间接受HT的201例18岁以上患者进行回顾性分析。患者被分为发生CMV疾病的两个风险亚组：高风险组（D+/R-或接受输血的D-/R-或R-，或供者血清学状态未知）和低风险组（任何其他组合）。
201例患者（平均年龄53.81±11.61岁，81.1%为男性）。165例患者被归类为低风险组，36例为高风险组。HT后第一年无症状CMV感染的累积发生率为47%：低风险组为46%，高风险组为50%（P = 0.668）。HT后第一年CMV疾病的发生率为7.5%：低风险组为3.6%，高风险组为25%（P < 0.001）。
在我们的系列研究中，HT后无症状CMV感染很常见，几乎影响50%的患者。然而，CMV疾病的发生率非常低（7.5%），这证实了PET的有效性。高风险组中疾病发生率较高，建议对这些患者密切监测病毒载量或进行更长时间的普遍预防。
