Reischig Tomas, Kacer Martin, Hruba Petra, Jindra Pavel, Hes Ondrej, Lysak Daniel, Bouda Mirko, Viklicky Ondrej
Department of Internal Medicine I, Charles University Medical School and Teaching Hospital, Pilsen, Czech Republic.
Biomedical Centre, Faculty of Medicine in Pilsen, Charles University, Pilsen, Czech Republic.
Antivir Ther. 2017;22(6):503-513. doi: 10.3851/IMP3129. Epub 2017 Jan 16.
Asymptomatic cytomegalovirus (CMV) infection is associated with graft dysfunction and failure. However, no study assessed CMV viral load in terms of the risk for graft failure.
In a prospective cohort of kidney transplant recipients, we assessed the impact of CMV DNAemia on the overall graft survival and the incidence of moderate-to-severe interstitial fibrosis and tubular atrophy (IF/TA) in protocol biopsy at 36 months. CMV DNAemia was stratified by viral load in whole blood.
A total of 180 patients transplanted from October 2003 through January 2011 were included and followed for 4 years; 87 (48%) patients received 3-month prophylaxis with valacyclovir and 45 (25%) with valganciclovir; 48 (27%) were managed by pre-emptive therapy. Within 12 months of transplantation, CMV DNAemia developed in 102 (57%) patients with 36 (20%) having a viral load of ≥2,000 copies/ml. Multivariate Cox analysis identified CMV DNAemia as an independent risk factor for graft loss (hazard ratio 3.42; P=0.020); however, after stratification by viral load, only CMV DNAemia ≥2,000 copies/ml (hazard ratio 7.62; P<0.001) remained significant. Both early-onset (<3 months; P=0.048) and late-onset (>3 months; P<0.001) CMV DNAemia ≥2,000 copies/ml were risk factors for graft loss. The incidence of moderate-to-severe IF/TA was not significantly influenced by CMV DNAemia.
Kidney transplant recipients having CMV DNAemia with a higher viral load irrespective of the time to onset are at increased risk for graft loss.
无症状巨细胞病毒（CMV）感染与移植物功能障碍及衰竭相关。然而，尚无研究根据移植物衰竭风险评估CMV病毒载量。
在一个肾移植受者前瞻性队列中，我们评估了CMV血症对总体移植物存活以及36个月时方案活检中中重度间质纤维化和肾小管萎缩（IF/TA）发生率的影响。CMV血症根据全血中的病毒载量进行分层。
纳入了2003年10月至2011年1月期间移植的180例患者，并随访4年；87例（48%）患者接受了3个月的伐昔洛韦预防治疗，45例（25%）接受了缬更昔洛韦预防治疗；48例（27%）采用抢先治疗。移植后12个月内，102例（57%）患者发生了CMV血症，其中36例（20%）病毒载量≥2000拷贝/ml。多因素Cox分析确定CMV血症是移植物丢失的独立危险因素（风险比3.42；P=0.020）；然而，按病毒载量分层后，仅CMV血症≥2000拷贝/ml（风险比7.62；P<0.001）仍具有显著性。CMV血症≥2000拷贝/ml的早发（<3个月；P=0.048）和晚发（>3个月；P<0.001）均为移植物丢失的危险因素。中重度IF/TA的发生率未受到CMV血症的显著影响。
无论发病时间如何，具有较高病毒载量的CMV血症肾移植受者发生移植物丢失的风险增加。
