肾移植中巨细胞病毒 DNA 血症自发清除的预测因素。
Predictive factors of spontaneous CMV DNAemia clearance in kidney transplantation.
机构信息
Service de néphrologie et transplantation rénale, CHRU de Tours, Tours, France; EA4245 Cellules Dendritiques et Greffes, Université François-Rabelais, Tours, France.
Service de néphrologie et transplantation rénale, CHRU de Tours, Tours, France; EA4245 Cellules Dendritiques et Greffes, Université François-Rabelais, Tours, France.
出版信息
J Clin Virol. 2018 Feb-Mar;99-100:38-43. doi: 10.1016/j.jcv.2017.12.011. Epub 2017 Dec 29.
UNLABELLED
Cytomegalovirus (CMV) infection occurs frequently after solid organ transplantation. Therapeutic strategies, in particular when to start a curative treatment, has not yet been defined. The purpose of this study was to assess predictive factors associated with spontaneous clearance of CMV DNAemia in kidney transplant recipients.
METHODS
All kidney recipients of a single center were recruited. Patients with at least one positive CMV DNAemia during the first year post transplantation were included in our analysis. Whole blood CMV PCR was performed using Abbott RealTime CMV, calibrated according to WHO standards and expressed in log10 IU/ml (Detection = 1.79 IU log10/ml). Post transplantation, prophylaxis (valganciclovir) was given for 3 months for CMV positive recipients (R+) and 6 months for CMV positive donors giving to seronegative recipients (D + R-). Clinical and biological symptoms attributable to CMV were collected. We defined as spontaneous CMV clearance undetectable DNAemia before the fourth follow up without treatment. Results were expressed as mean ± SD. Results were prospectively assessed in a French multicenter validation cohort.
RESULTS
Between 05/2012 and 05/2015, 95 patients had at least one positive CMV DNAemia. Thirty-six (37.8%) had spontaneous undetectable DNAemia. Fifty-nine patients had non-spontaneous CMV clearance. ROC analysis showed that an initial CMV DNAemia <2.75 log10/IU/mL was optimal to predict CMV spontaneous clearance. On multivariate analysis, factors associated with spontaneous CMV clearance were initial PCR level lower than 2.75 log10/IU/ml (OR = 33.8, 95% CI [7.1-160.0]), and absence of CMV DNAemia increase of more than 1 log10 between two analyses (OR = 128.0, 95% CI [11.9-1368.0]). Clinical and biological abnormalities were not associated CMV DNAemia spontaneous clearance. Observations made for the principal cohort were validated in an independent cohort of 49 kidney transplanted patients.
CONCLUSIONS
Initial standardized CMV DNAemia level and evolution of DNAemia are the principal factors associated with CMV spontaneous clearance.
目的
评估与肾移植受者巨细胞病毒（CMV）DNA 血症自发清除相关的预测因素。
方法
招募了一个中心的所有肾移植受者。纳入了在移植后 1 年内至少有一次 CMV DNA 血症阳性的患者。使用 Abbott RealTime CMV 进行全血 CMV PCR，根据世界卫生组织（WHO）标准进行校准，并以 log10 IU/ml 表示（检测= 1.79 IU log10/ml）。移植后，CMV 阳性受者（R+）给予缬更昔洛韦预防治疗 3 个月，CMV 阳性供者给予阴性受者（D+R-）预防治疗 6 个月。收集与 CMV 相关的临床和生物学症状。我们定义未治疗前第 4 次随访时不可检测的 DNA 血症为 CMV 自发清除。结果表示为平均值±标准差。结果在一个法国多中心验证队列中进行前瞻性评估。
结果
2012 年 5 月至 2015 年 5 月期间，95 例患者至少有一次 CMV DNA 血症阳性。36 例（37.8%）出现自发不可检测的 DNA 血症。59 例患者出现非自发性 CMV 清除。ROC 分析显示，初始 CMV DNA 血症<2.75 log10IU/ml 是预测 CMV 自发清除的最佳指标。多变量分析显示，与 CMV 自发清除相关的因素是初始 PCR 水平低于 2.75 log10IU/ml（OR=33.8，95%CI [7.1-160.0]），以及两次分析之间 CMV DNA 血症增加超过 1 log10 的次数（OR=128.0，95%CI [11.9-1368.0]）。临床和生物学异常与 CMV DNA 血症自发清除无关。在一个包含 49 例肾移植患者的独立队列中验证了对主要队列的观察结果。
结论
初始标准化 CMV DNA 血症水平和 DNA 血症的变化是与 CMV 自发清除相关的主要因素。
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