Transplantation Center, University Hospital (CHUV) and University of Lausanne, Lausanne, Switzerland; Infectious Diseases Service, University Hospital (CHUV) and University of Lausanne, Lausanne, Switzerland.
Am J Transplant. 2013 Sep;13(9):2402-10. doi: 10.1111/ajt.12388. Epub 2013 Aug 5.
We assessed the impact of antiviral prophylaxis and preemptive therapy on the incidence and outcomes of cytomegalovirus (CMV) disease in a nationwide prospective cohort of solid organ transplant recipients. Risk factors associated with CMV disease and graft failure-free survival were analyzed using Cox regression models. One thousand two hundred thirty-nine patients transplanted from May 2008 until March 2011 were included; 466 (38%) patients received CMV prophylaxis and 522 (42%) patients were managed preemptively. Overall incidence of CMV disease was 6.05% and was linked to CMV serostatus (D+/R- vs. R+, hazard ratio [HR] 5.36 [95% CI 3.14-9.14], p < 0.001). No difference in the incidence of CMV disease was observed in patients receiving antiviral prophylaxis as compared to the preemptive approach (HR 1.16 [95% CI 0.63-2.17], p = 0.63). CMV disease was not associated with a lower graft failure-free survival (HR 1.27 [95% CI 0.64-2.53], p = 0.50). Nevertheless, patients followed by the preemptive approach had an inferior graft failure-free survival after a median of 1.05 years of follow-up (HR 1.63 [95% CI 1.01-2.64], p = 0.044). The incidence of CMV disease in this cohort was low and not influenced by the preventive strategy used. However, patients on CMV prophylaxis were more likely to be free from graft failure.
我们评估了抗病毒预防和抢先治疗对器官移植受者的巨细胞病毒（CMV）疾病发生率和结局的影响。使用 Cox 回归模型分析了与 CMV 疾病和移植物无失败生存相关的风险因素。共纳入了 1239 例 2008 年 5 月至 2011 年 3 月期间进行的实体器官移植患者；466 例（38%）患者接受 CMV 预防治疗，522 例（42%）患者接受抢先治疗。CMV 疾病的总发生率为 6.05%，与 CMV 血清状态相关（D+/R-比 R+，危险比[HR]5.36[95%CI3.14-9.14]，p<0.001）。与抢先治疗相比，接受抗病毒预防治疗的患者中 CMV 疾病的发生率无差异（HR1.16[95%CI0.63-2.17]，p=0.63）。CMV 疾病与移植物无失败生存无关（HR1.27[95%CI0.64-2.53]，p=0.50）。然而，在中位随访 1.05 年后，采用抢先治疗的患者的移植物无失败生存较差（HR1.63[95%CI1.01-2.64]，p=0.044）。该队列中 CMV 疾病的发生率较低，且不受所使用的预防策略影响。然而，接受 CMV 预防治疗的患者更有可能避免发生移植物失败。
