Low Chian Yong, Hosseini-Moghaddam Seyed Mohammadmehdi, Rotstein Coleman, Renner Eberhard L, Husain Shahid
Division of Infectious Diseases, University of Toronto, University Health Network, Toronto, ON, Canada.
Multi-Organ Transplant Program, University of Toronto, University Health Network, Toronto, ON, Canada.
Transpl Infect Dis. 2017 Oct;19(5). doi: 10.1111/tid.12736. Epub 2017 Aug 7.
The effects of different immunoprophylaxis regimens on cytomegalovirus (CMV) infection in liver transplant recipients (LTRs) have not been compared.
In a cohort, we studied 343 CMV-seropositive recipient (R+) and 83 seronegative donor/recipient (D-/R-) consecutive LTRs from 2004 to 2007. Immunoprophylaxis regimens included steroid-only, steroids plus rabbit anti-thymocyte globulin (rATG), and steroids plus basiliximab. Logistic regression analysis, Cox proportional hazards regression model, and log-rank test were performed for multivariate analysis as appropriate.
In total, 164 (39%), 69 (16%), and 193 (45%) patients received steroid-only, basiliximab, and rATG immunoprophylaxis, respectively. CMV infection rates were 15.7% (54/343) in CMV R+ LTRs and 2.4% (2/83) in CMV R- LTRs. Among CMV R+ LTRs who received rATG, the use of at least 6 weeks of CMV prophylaxis reduced the rate of CMV infection from 24.4% (19/78) to 11.7% (9/77). In multivariate analysis, CMV R+ vs D-/R- (odds ratio [OR]=13.1, 95% confidence interval [CI]: 1.8-97.2), rATG >3 mg/kg vs steroid-only induction (OR=1.6, 95% CI: 1.1-2.3), and CMV prophylaxis <6 weeks vs ≥6 weeks (OR=2.7, 95% CI: 1.2-6.4) were independently associated with CMV infection. Subgroup analysis in CMV D-/R+ group who received rATG showed that ≥6 weeks of CMV prophylaxis significantly decreased the risk of CMV infection (OR=1.9, 95% CI: 1.1-3.9; P=.03).
The use of rATG immunoprophylaxis increases the risk of CMV infection in CMV-seropositive LTRs, specifically in the CMV D-/R+ group. Prophylaxis with valganciclovir in this group for at least 6 weeks decreases the risk of CMV infection.
尚未比较不同免疫预防方案对肝移植受者（LTR）巨细胞病毒（CMV）感染的影响。
在一个队列中，我们研究了2004年至2007年连续的343例CMV血清学阳性受者（R+）和83例血清学阴性供者/受者（D-/R-）的LTR。免疫预防方案包括仅用类固醇、类固醇加兔抗胸腺细胞球蛋白（rATG）以及类固醇加巴利昔单抗。酌情进行逻辑回归分析、Cox比例风险回归模型和对数秩检验以进行多变量分析。
总共164例（39%）、69例（16%）和193例（45%）患者分别接受了仅用类固醇、巴利昔单抗和rATG免疫预防。CMV R+ LTR中的CMV感染率为15.7%（54/343），CMV R- LTR中的感染率为2.4%（2/83）。在接受rATG的CMV R+ LTR中，使用至少6周的CMV预防可将CMV感染率从24.4%（19/78）降至11.7%（9/77）。在多变量分析中，CMV R+与D-/R-（比值比[OR]=13.1，95%置信区间[CI]：1.8 - 97.2）、rATG>3mg/kg与仅用类固醇诱导（OR=1.6，95%CI：1.1 - 2.3）以及CMV预防<6周与≥6周（OR=2.7，95%CI：1.2 - 6.4）与CMV感染独立相关。在接受rATG的CMV D-/R+组的亚组分析中，CMV预防≥6周显著降低了CMV感染风险（OR=1.9，95%CI：1.1 - 3.9；P = 0.03）。
使用rATG免疫预防会增加CMV血清学阳性LTR中CMV感染的风险，特别是在CMV D-/R+组中。该组用缬更昔洛韦预防至少6周可降低CMV感染风险。
