供者巨细胞病毒血清流行率与肝移植受者机会性病毒感染。

Seroprevalence of cytomegalovirus in donors & opportunistic viral infections in liver transplant recipients.

机构信息

Institute of Liver Disease and Transplantation, Gleneagles Global Health City, Chennai, India.

Department of Infectious Disease, Gleneagles Global Health City, Chennai, India.

出版信息

Indian J Med Res. 2017 Apr;145(4):558-562. doi: 10.4103/ijmr.IJMR_1024_14.

DOI:10.4103/ijmr.IJMR_1024_14

PMID:28862190

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC5663172/

Abstract

BACKGROUND & OBJECTIVES: Opportunistic virus infections are common in liver transplant (LT) recipients. There is a risk of developing infection with cytomegalovirus (CMV) and herpes-related viruses such as herpes simplex virus-1 and 2 (HSV-1 & 2), Epstein-Barr virus (EBV) and Varicella Zoster virus (VZV), reactivation of infection and recurrent infection. This study was conducted to determine CMV seropositivity in donors and its influence on LT recipients and seropositivity of CMV, HSV-1 and 2, EB viral capsid antigen (EBVCA) and VZV in LT recipients and their reactivation.

METHODS

Pre-transplant data for IgG and IgM for CMV (and donor), HSV-1 and -2, EB viral capsid antigen (VCA) and VZV were available for 153 recipients. All recipients were on ganciclovir or valganciclovir prophylaxis for three months after LT. For reactivation rates, findings of post-transplant CMV quantitative reverse transcription polymerase chain reaction (CMV qRT-PCR) assay were associated with pre-transplant serological profile.

RESULTS

Of the 153 LT recipients, 131 were men (85.6%). The median age of LT was 46 yr (range 9 months-71 yr). Overall exposure to CMV was 71.8 per cent followed by EB VCA (61.4%) and VZV (49.6%). Susceptibility to both HSV-1 and -2 was high across all decades (P<0.001). Seropositivity of CMV in donor was 90.9 per cent (100 out of 110). Post-transplant CMV qRT- PCR was positive in 17 (26.6%; 3 in recipient negative) of 64 samples tested. qRT-PCR assay was positive in one out of four (25%) tested for HSV-1 and nine out of 19 (47.4%) tested for EBV. Two recipients tested for HSV-2 and one for VZV were negative. There were three deaths in recipients (D+ R+) who were also positive for CMV qRT PCR. There was one death due to HSV-1 pneumonia. One patient with EBV reactivation developed post-transplant lymphoproliferative disorder two years after transplant.

INTERPRETATION & CONCLUSIONS: Transplant recipient were at highest risk of acquiring HSV-1 and -2 more so for HSV-2. CMV exposure in transplant recipients and donors were very high and at greatest risk for recipient reactivation rate. Despite this, death related to CMV reactivation was low.

摘要

背景与目的

机会性病毒感染在肝移植（LT）受者中很常见。存在巨细胞病毒（CMV）和疱疹相关病毒（如单纯疱疹病毒 1 和 2（HSV-1 和 2）、EB 病毒（EBV）和水痘带状疱疹病毒（VZV）感染、再激活和复发性感染的风险。本研究旨在确定供体中的 CMV 血清阳性率及其对 LT 受者的影响，以及 LT 受者中 CMV、HSV-1 和 2、EB 病毒衣壳抗原（EBVCA）和 VZV 的血清阳性率及其再激活。

方法

为 153 名受者提供了 CMV（和供体）、HSV-1 和 -2、EB 病毒衣壳抗原（VCA）和 VZV 的 IgG 和 IgM 的移植前数据。所有受者在 LT 后均接受更昔洛韦或缬更昔洛韦预防治疗三个月。为了确定再激活率，将移植后 CMV 定量逆转录聚合酶链反应（CMV qRT-PCR）检测结果与移植前的血清学特征相关联。

结果

在 153 名 LT 受者中，131 名为男性（85.6%）。LT 的中位年龄为 46 岁（范围 9 个月至 71 岁）。总体上，CMV 的暴露率为 71.8%，其次是 EBV VCA（61.4%）和 VZV（49.6%）。所有十年中，对 HSV-1 和 -2 的易感性均很高（P<0.001）。供体中 CMV 的血清阳性率为 90.9%（100/110）。在 64 个测试样本中，17 个（26.6%；3 个在受者阴性）的移植后 CMV qRT-PCR 为阳性。在四个测试的一个（25%）中，HSV-1 的 qRT-PCR 检测为阳性，在 19 个测试的九个（47.4%）中，EBV 的 qRT-PCR 检测为阳性。两个测试 HSV-2 的和一个测试 VZV 的受者均为阴性。在 qRT-PCR 检测为阳性的 3 名（D+R+）受者中，有 3 名受者死亡。有 1 例因 HSV-1 肺炎死亡。1 例 EBV 再激活患者在移植后两年发生移植后淋巴组织增生性疾病。