Division of Geographic Medicine and Infectious Diseases, Tufts Medical Center and Tufts University School of Medicine.
Institute for Clinical Research and Health Policy Studies, Tufts Medical Center.
Clin Infect Dis. 2017 Nov 29;65(12):2000-2007. doi: 10.1093/cid/cix696.
Cytomegalovirus (CMV) is a major contributor to morbidity and mortality in solid organ transplant recipients (SOTRs). Ganciclovir and valganciclovir are highly effective antiviral drugs with a well-established role in primary prophylaxis and treatment of CMV disease. Our objective in this study was to examine the effect of secondary prophylaxis (SP) on the risk of relapse in SOTRs following an episode of CMV disease.
We performed a retrospective cohort study of SOTRs from 1995 to 2015 and used propensity score-based inverse probability of treatment weighting methodology to control for confounding by indication. A weighted Cox model was created to determine the effect of SP on time to relapse within 1 year of treatment completion.
Fifty-two heart, 34 liver, 79 kidney, and 5 liver-kidney transplant recipients who completed treatment for an episode of CMV infection/disease were included. A total of 120 (70.6%) received SP (median duration, 61 days; range, 5-365) and 39 (23%) relapsed. SP was protective against relapse from 0 to 6 weeks following treatment completion (hazard ratio [HR], 0.19; 95% confidence interval [CI], 0.05-0.69). However, after 6 weeks, risk of relapse did not significantly differ between the 2 groups (HR, 1.18; 95% CI, 0.46-2.99).
Our findings demonstrate that use of SP following treatment of CMV disease did not confer long-term protection against relapse, although it did delay relapse while patients were receiving antivirals. This suggests that SP has limited clinical utility in the overall prevention of recurrent CMV disease.
巨细胞病毒(CMV)是实体器官移植受者(SOTR)发病率和死亡率的主要原因。更昔洛韦和缬更昔洛韦是两种高效的抗病毒药物,在 CMV 疾病的一级预防和治疗中具有明确的作用。我们在这项研究中的目的是检查二级预防(SP)对 CMV 疾病发作后 SOTR 复发风险的影响。
我们对 1995 年至 2015 年的 SOTR 进行了回顾性队列研究,并使用倾向评分逆概率治疗加权方法控制混杂因素。创建了一个加权 Cox 模型来确定 SP 对治疗完成后 1 年内复发时间的影响。
52 例心脏、34 例肝脏、79 例肾脏和 5 例肝-肾移植受者完成了 CMV 感染/疾病的治疗。共有 120 例(70.6%)接受了 SP(中位数持续时间 61 天;范围 5-365 天),39 例(23%)复发。SP 在治疗完成后 0 至 6 周内对复发有保护作用(风险比[HR],0.19;95%置信区间[CI],0.05-0.69)。然而,6 周后,两组之间的复发风险无显著差异(HR,1.18;95%CI,0.46-2.99)。
我们的研究结果表明,在治疗 CMV 疾病后使用 SP 并不能提供长期的复发保护,尽管它在患者接受抗病毒治疗时确实延迟了复发。这表明 SP 在预防复发性 CMV 疾病方面的临床应用有限。