Beam E, Lesnick T, Kremers W, Kennedy C C, Razonable R R
Infectious Diseases, Mayo Clinic College of Medicine, Rochester, MN, USA.
Health Sciences Research, Mayo Clinic College of Medicine, Rochester, MN, USA.
Clin Transplant. 2016 Mar;30(3):270-8. doi: 10.1111/ctr.12686. Epub 2016 Mar 1.
The duration of anticytomegalovirus (CMV) prophylaxis after lung transplantation (LT) varies among transplant centers.
A retrospective review of CMV donor-seropositive/recipient-seronegative (D+/R-) and CMV recipient-seropositive (R+) LT patients between January 2005 and September 2012 was performed. Starting January 2007, valganciclovir prophylaxis was given for at least 12 months (often lifelong) for CMV D+/R- and extended from three to six months for R+ LT patients. Risks of CMV infection and CMV disease, and mortality after LT, were assessed.
A total of 88 LT patients were studied, including 32 CMV D+/R-, and 56 R+ patients. During the follow-up period, 11 (12.5%) patients had asymptomatic CMV infection, and nine (10.3%) developed CMV disease. CMV disease (HR, 4.189; 95% CI: 1.672-10.495; p = 0.002) and CMV infection and disease (HR, 3.775; 95% CI: 1.729-8.240; p = 0.001) were significant risk factors for mortality. Overall, no significant difference was observed in rates of CMV infection or disease among LT recipients who received shorter vs. extended CMV prophylaxis.
Despite extended prophylaxis, LT patients remain at risk of CMV infection and disease. CMV remains associated with increased mortality after transplantation.
肺移植（LT）后抗巨细胞病毒（CMV）预防的持续时间在各移植中心有所不同。
对2005年1月至2012年9月期间的CMV供体血清学阳性/受体血清学阴性（D+/R-）和CMV受体血清学阳性（R+）的LT患者进行回顾性研究。从2007年1月开始，对CMV D+/R-患者给予缬更昔洛韦预防至少12个月（通常为终身），对R+ LT患者预防时间从3个月延长至6个月。评估CMV感染和CMV疾病的风险以及LT后的死亡率。
共研究了88例LT患者，包括32例CMV D+/R-患者和56例R+患者。在随访期间，11例（12.5%）患者发生无症状CMV感染，9例（10.3%）发生CMV疾病。CMV疾病（风险比[HR]，4.189；95%置信区间[CI]：1.672 - 10.495；p = 0.002）以及CMV感染和疾病（HR，3.775；95% CI：1.729 - 8.240；p = 0.001）是死亡的显著危险因素。总体而言，接受较短或延长CMV预防的LT受者中，CMV感染或疾病发生率无显著差异。
尽管进行了延长预防，LT患者仍有CMV感染和疾病的风险。CMV仍然与移植后死亡率增加相关。
