Unit of Infectious Diseases, Instituto de Investigación Hospital 12 de Octubre (i+12), University Hospital 12 de Octubre, Universidad Complutense, Madrid, Spain.
J Clin Virol. 2013 Apr;56(4):316-22. doi: 10.1016/j.jcv.2012.12.010. Epub 2013 Jan 4.
The strength of the assumed association of CMV and long term deleterious events in solid organ transplant recipients (SOT) is controversial.
The aim of the present study was to evaluate whether viral replication dynamics during CMV infection or CMV disease may correlate not only with graft dysfunction and survival, but also with other potentially related late events in a long-term followed cohort of kidney (KT) and liver (LT) transplant recipients.
162 SOT (104 kidney, 58 liver) at our institution (2003-2005) with survival over 180 days and a median follow-up of 71 months (9-86) were analyzed. Using a Cox proportional hazard model, CMV infection (including area under the curve of DNAemia[AUC]) and CMV disease in the first 180 days were evaluated as potential predictors of the following late events (>180 days): mortality, graft dysfunction (GD), graft loss (GL), cardiovascular events (CVE), malignant tumors (MT).
CMV infection occurred in 59% and CMV disease in 8%. Late death occurred in 17%, GD in 45.6%, GL in 14.2%, CVE in 10.5% and MT in 9.9%. We found no significant association between the intensity or duration of CMV viremia (AUC, persistent viremia or untreated CMV viremia) or CMV disease and the development of evaluated late events. According multivariate analysis neither CMV infection (hazard ratio [HR] 2.18 95% CI 0.949-5 p = 0.066) nor CMV disease (HR: 1.72; 95% CI 0.59-5 p = 0.31) were significantly correlated with late mortality.
Our data do not support that CMV infection or CMV disease contribute significantly to long-term deleterious events in SOT.
巨细胞病毒（CMV）与实体器官移植受者（SOT）长期不良事件之间的关联强度存在争议。
本研究旨在评估 CMV 感染期间或 CMV 疾病期间的病毒复制动力学是否不仅与移植物功能障碍和存活率相关，而且还与长期随访的肾脏（KT）和肝脏（LT）移植受者队列中的其他潜在相关晚期事件相关。
对本机构 2003-2005 年期间存活时间超过 180 天且中位随访时间为 71 个月（9-86 个月）的 162 名 SOT（104 名肾脏，58 名肝脏）进行分析。使用 Cox 比例风险模型，评估前 180 天内的 CMV 感染（包括 DNAemia 的 AUC）和 CMV 疾病是否为以下晚期事件（>180 天）的潜在预测因子：死亡率、移植物功能障碍（GD）、移植物丢失（GL）、心血管事件（CVE）、恶性肿瘤（MT）。
59%的患者发生 CMV 感染，8%的患者发生 CMV 疾病。晚期死亡发生率为 17%，GD 为 45.6%，GL 为 14.2%，CVE 为 10.5%，MT 为 9.9%。我们发现 CMV 病毒血症的强度或持续时间（AUC、持续病毒血症或未治疗的 CMV 病毒血症）或 CMV 疾病与评估的晚期事件的发展之间没有显著关联。多变量分析显示，CMV 感染（危险比[HR]2.18，95%CI0.949-5，p=0.066）或 CMV 疾病（HR：1.72；95%CI0.59-5，p=0.31）均与晚期死亡率无显著相关性。
我们的数据不支持 CMV 感染或 CMV 疾病对 SOT 的长期不良事件有显著贡献。
