巨细胞病毒血清学阳性肺移植受者的危险因素、生存率及预防疗程的影响：一项前瞻性、观察性、多中心研究。

Risk factors, survival, and impact of prophylaxis length in cytomegalovirus-seropositive lung transplant recipients: A prospective, observational, multicenter study.

作者信息

Monforte Victor, Sintes Helena, López-Gallo Cristina, Delgado Maria, Santos Francisco, Zurbano Felipe, Solé Amparo, Gavaldá Joan, Borro Jose Maria, Redel-Montero Javier, Cifrian Jose Manuel, Pastor Amparo, Román Antonio, Ussetti Piedad

机构信息

Respiratory Department, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain.

Ciber Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain.

出版信息

Transpl Infect Dis. 2017 Jun;19(3). doi: 10.1111/tid.12694. Epub 2017 May 9.

DOI:10.1111/tid.12694

PMID:28294487

Abstract

BACKGROUND

The optimal length of cytomegalovirus (CMV) prophylaxis in lung transplantation according to CMV serostatus is not well established.

METHODS

We have performed a prospective, observational, multicenter study to determine the incidence of CMV infection and disease in 92 CMV-seropositive lung transplant recipients (LTR), their related outcomes and risk factors, and the impact of prophylaxis length.

RESULTS

At 18 months post transplantation, 37 patients (40%) developed CMV infection (23 [25%]) or disease (14 [15.2%]). Overall mortality was higher in patients with CMV disease (64.3% vs 10.2%; P<.001), but only one patient died from CMV disease. In the multivariate analysis, CMV disease was an independent death risk factor (odds ratio [OR] 18.214, 95% confidence interval [CI] 4.120-80.527; P<.001). CMV disease incidence was higher in patients with 90-day prophylaxis than in those with 180-day prophylaxis (31.3% vs 11.8%; P=.049). Prophylaxis length was an independent risk factor for CMV disease (OR 4.974, 95% CI 1.231-20.094; P=.024). Sixteen patients withdrew from prophylaxis because of adverse events.

CONCLUSION

CMV infection and disease in CMV-seropositive LTR remain frequent despite current prophylaxis. CMV disease increases mortality, whereas 180-day prophylaxis reduces the incidence of CMV disease.

摘要

背景

根据巨细胞病毒（CMV）血清学状态确定肺移植中CMV预防的最佳时长尚未明确。

方法

我们开展了一项前瞻性、观察性、多中心研究，以确定92例CMV血清学阳性的肺移植受者（LTR）中CMV感染和疾病的发生率、其相关结局和危险因素，以及预防时长的影响。

结果

移植后18个月时，37例患者（40%）发生了CMV感染（23例[25%]）或疾病（14例[15.2%]）。CMV疾病患者的总体死亡率更高（64.3%对10.2%；P<0.001），但仅有1例患者死于CMV疾病。多变量分析中，CMV疾病是独立的死亡风险因素（比值比[OR]18.214，95%置信区间[CI]4.120 - 80.527；P<0.001）。接受90天预防的患者中CMV疾病发生率高于接受180天预防的患者（31.3%对11.8%；P = 0.049）。预防时长是CMV疾病的独立危险因素（OR 4.974，95% CI 1.231 - 20.094；P = 0.024）。16例患者因不良事件停止预防。