Felipe Claudia Rosso, Ferreira Alexandra Nicolau, Bessa Adrieli, Abait Tamiris, Ruppel Priscilla, Paula Mayara Ivani de, Hiramoto Liliane, Viana Laila, Martins Suelen, Cristelli Marina, Aguiar Wilson, Mansur Juliana, Basso Geovana, Silva Junior Helio Tedesco, Pestana Jose Medina
Universidade Federal de São Paulo, Hospital do Rim, Disciplina de Urologia, São Paulo - SP, Brazil.
J Bras Nefrol. 2017 Oct-Dec;39(4):413-423. doi: 10.5935/0101-2800.20170074.
Cytomegalovirus (CMV) infection in kidney transplantation has changed its clinical spectrum, mostly due to the current and more effective immunosuppression. In the absence of preventive strategies it is associated with significant morbi-mortality.
This study evaluated the incidence of CMV events and its effect on outcomes of kidney transplantation in recipients without pharmacological prophylaxis or targeted preemptive treatment.
The study cohort comprised 802 recipients of kidney transplants between 04/30/2014 and 04/30/2015. The majority received induction with anti-thymocyte globulin (81.5%), tacrolimus and prednisone in combination with either mycophenolate (46.3%) or azathioprine (53.7%). The overall incidence of CMV events was 42% (58.6% infection and 41.4% disease). Patients with CMV showed higher incidence of first treated acute rejection (19 vs. 11%, p = 0,001) compared with those without CMV but no differences in graft loss, death or loss to follow-up. The incidence of delayed graft function was higher (56% vs. 37%, p = 0.000) and the eGFR at 1 (41 ± 21 vs. 54 ± 28 ml/min, p = 0.000) and 12 months (50 ± 19 vs. 61 ± 29 ml/min, p = 0.000) were lower in patients with CMV. Recipients age (OR = 1.03), negative CMV serology (OR = 5.21) and use of mycophenolate (OR = 1.67) were associated with increased risk of CMV. Changes in immunosuppression was more often in patients with CMV (63% vs. 31%, p = 0.000).
the incidence of CMV events was high and associated with higher incidence of acute rejection and changes in immunosuppression. Besides traditional risk factors, renal function at 1 month was independently associated with CMV infection.
肾移植中的巨细胞病毒（CMV）感染已改变其临床谱，主要归因于当前更有效的免疫抑制措施。在缺乏预防策略的情况下，它与显著的发病和死亡相关。
本研究评估了在未接受药物预防或靶向抢先治疗的肾移植受者中CMV事件的发生率及其对肾移植结局的影响。
研究队列包括2014年4月30日至2015年4月30日期间的802例肾移植受者。大多数患者接受抗胸腺细胞球蛋白诱导治疗（81.5%），他克莫司和泼尼松联合霉酚酸（46.3%）或硫唑嘌呤（53.7%）。CMV事件的总体发生率为42%（感染占58.6%，疾病占41.4%）。与无CMV的患者相比，CMV患者首次治疗的急性排斥发生率更高（19%对11%，p = 0.001），但在移植物丢失、死亡或失访方面无差异。CMV患者延迟移植肾功能的发生率更高（56%对37%，p = 0.000），1个月时的估算肾小球滤过率（eGFR）更低（41±21对54±28 ml/min，p = 0.000），12个月时也更低（50±19对61±29 ml/min，p = 0.000）。受者年龄（OR = 1.03）、CMV血清学阴性（OR = 5.21）和使用霉酚酸（OR = 1.67）与CMV风险增加相关。CMV患者更常发生免疫抑制的改变（63%对31%，p = 0.000）。
CMV事件的发生率较高，且与急性排斥的较高发生率和免疫抑制的改变相关。除了传统危险因素外，1个月时的肾功能与CMV感染独立相关。
