Kır O, Zeytinoğlu A, Arda B, Yılmaz M, Aşçı G, Töz H
Department of Internal Medicine, Ege University Medical School, Izmir, Turkey.
Department of Microbiology, Ege University Medical School, Izmir, Turkey.
Transplant Proc. 2017 Apr;49(3):537-540. doi: 10.1016/j.transproceed.2017.01.027.
Cytomegalovirus (CMV) is the most common viral infection during the post-transplant period, and it is one of the major causes of morbidity and mortality in kidney transplantation. In this study, the incidence and impact of pre-emptive and prophylactic approaches and long-term effects on graft and patient survival of CMV infection were investigated. Among 493 adult kidney transplant recipients, pretransplant CMV IgG-negative patients and patients with a follow-up shorter than a month were excluded. The patients were divided into 2 groups: pre-emptive group (n = 187, regular screening and acyclovir 400 mg twice daily for 6 months), and prophylaxis group (n = 275, valganciclovir 450 mg/d for 3 months). The pre-emptive group was screened for CMV with either pp65 antigenemia or CMV DNA. There were 462 patients, and mean follow-up was 37.7 months. There were more CMV infections in the pre-emptive group than in the prophylaxis group (n = 56, 30.1% vs n = 12, 4.4%, respectively; P < .001). Late CMV infections were significantly more frequent in the prophylaxis group (10 of 12, 83.3%) than in the pre-emptive group (8 of 56, 14.3%, P < .001). In multivariate analysis, valganciclovir prophylaxis was associated with a lower CMV infection (relative risk [RR]: 0.18, 95% confidence interval [CI] 0.08 to 0.39, P < .001). Delayed graft function was the only independent risk factor for graft loss during the follow-up on multivariate Cox regression analysis (RR: 2.66, 95% GA 1.17 to 6.04, P = .02). Valganciclovir prophylaxis was more protective against CMV infection than the pre-emptive approach. Neither prophylaxis/pre-emptive approaches nor CMV infection had negative effect on graft and patient survival.
巨细胞病毒（CMV）是移植后时期最常见的病毒感染，也是肾移植发病和死亡的主要原因之一。在本研究中，调查了抢先治疗和预防方法的发生率及影响，以及CMV感染对移植物和患者生存的长期影响。在493例成年肾移植受者中，排除了移植前CMV IgG阴性患者和随访时间短于1个月的患者。患者分为2组：抢先治疗组（n = 187，定期筛查并口服阿昔洛韦400 mg，每日2次，共6个月）和预防组（n = 275，口服缬更昔洛韦450 mg/d，共3个月）。抢先治疗组采用pp65抗原血症或CMV DNA筛查CMV。共有462例患者，平均随访37.7个月。抢先治疗组的CMV感染多于预防组（分别为n = 56，30.1% 与n = 12，4.4%；P <.001）。预防组的晚期CMV感染明显多于抢先治疗组（12例中的10例，83.3% 对比56例中的8例，14.3%，P <.001）。多因素分析中，缬更昔洛韦预防与较低的CMV感染相关（相对危险度[RR]：0.18，95%置信区间[CI] 0.08至0.39，P <.001）。在多因素Cox回归分析中，移植肾功能延迟是随访期间移植物丢失的唯一独立危险因素（RR：2.66，95% GA 1.17至6.04，P =.02）。缬更昔洛韦预防比抢先治疗方法对CMV感染更具保护作用。预防/抢先治疗方法和CMV感染对移植物和患者生存均无负面影响。
