Santos Carlos A Q, Brennan Daniel C, Yusen Roger D, Olsen Margaret A
1 Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine, St. Louis, MO. 2 Division of Renal Diseases, Department of Medicine, Washington University School of Medicine, St. Louis, MO. 3 Division of Pulmonary and Critical Care Medicine, Department of Medicine, Washington University School of Medicine, St. Louis, MO. 4 Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, MO.
Transplantation. 2015 Aug;99(8):1658-66. doi: 10.1097/TP.0000000000000549.
Cytomegalovirus (CMV) replication and disease commonly occur in lung transplant recipients after stopping anti-CMV prophylaxis. The epidemiology of CMV disease is not well studied, given the difficulties in assembling representative study populations with prolonged follow-up. We hypothesized that delayed-onset CMV disease (>100 days after transplantation) occurs more commonly than early-onset CMV disease in lung transplant recipients, and is associated with an increased risk of death.
We assembled a large cohort of lung transplant recipients using 2004 to 2010 International Classification of Diseases, Ninth Revision, Clinical Modification billing data from 3 Agency for Healthcare Research and Quality State Inpatient Databases, and identified demographics, comorbidities, CMV disease coded during hospital readmission and inpatient death. We used Cox proportional hazard multivariate analyses to assess for an independent association between delayed-onset CMV disease and death.
In the cohort of 1528 lung transplant recipients from 12 transplant centers, delayed-onset CMV disease occurred in 13.7% (n = 210) and early-onset CMV disease occurred in 3.3% (n = 51). Delayed-onset CMV pneumonitis was associated with inpatient death longer than 100 days after transplantation (adjusted hazard ratio, 1.6; 95% confidence interval [95% CI], 1.1-2.5), after adjusting for transplant failure/rejection (aHR, 2.5; 95% CI, 1.5-4.1), bacterial pneumonia (aHR, 2.8; 95% CI, 2.0-3.9), viral pneumonia (aHR, 1.5; 95% CI, 1.1-2.1), fungal pneumonia (aHR, 1.8; 95% CI, 1.3-2.3), single lung transplant (aHR, 1.3; 95% CI, 1.0-1.7), and idiopathic pulmonary fibrosis (aHR, 1.4; 95% CI, 1.0-1.8).
Delayed-onset CMV disease occurred more commonly than early-onset CMV disease among lung transplant recipients. These results suggest that delayed-onset CMV pneumonitis was independently associated with an increased risk of death.
巨细胞病毒（CMV）复制及疾病通常在肺移植受者停用抗CMV预防措施后发生。鉴于难以组建具有长期随访的代表性研究人群，CMV疾病的流行病学尚未得到充分研究。我们假设，在肺移植受者中，迟发性CMV疾病（移植后>100天）比早发性CMV疾病更常见，且与死亡风险增加相关。
我们利用来自3个医疗保健研究与质量机构的州住院患者数据库中的2004至2010年国际疾病分类第九版临床修订本计费数据，组建了一个大型肺移植受者队列，并确定了人口统计学特征、合并症、再次入院期间编码的CMV疾病以及住院死亡情况。我们使用Cox比例风险多变量分析来评估迟发性CMV疾病与死亡之间的独立关联。
在来自12个移植中心的1528例肺移植受者队列中，迟发性CMV疾病的发生率为13.7%（n = 210），早发性CMV疾病的发生率为3.3%（n = 51）。在调整移植失败/排斥反应（校正风险比，2.5；95%置信区间[95%CI]，1.5 - 4.1）、细菌性肺炎（校正风险比，2.8；95%CI，2.0 - 3.9）、病毒性肺炎（校正风险比，1.5；95%CI，1.1 - 2.1）、真菌性肺炎（校正风险比，1.8；95%CI，1.3 - 2.3）、单肺移植（校正风险比，1.3；95%CI，1.0 - 1.7）和特发性肺纤维化（校正风险比，1.4；95%CI，1.0 - 1.8）后，迟发性CMV肺炎与移植后100天以上的住院死亡相关（校正风险比，1.6；95%CI，1.1 - 2.5）。
在肺移植受者中，迟发性CMV疾病比早发性CMV疾病更常见。这些结果表明，迟发性CMV肺炎与死亡风险增加独立相关。
