Chitasombat Maria N, Watcharananan Siriorn P
Division of Infectious disease, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, 10400, Thailand.
F1000Res. 2018 Sep 28;7:1568. doi: 10.12688/f1000research.16321.1. eCollection 2018.
Cytomegalovirus (CMV) is an important cause of infectious complications after kidney transplantation (KT), especially among patients receiving antithymocyte globulin (ATG). CMV infection can result in organ dysfunction and indirect effects such as graft rejection, graft failure, and opportunistic infections Prevention of CMV reactivation includes pre-emptive or prophylactic approaches. Access to valganciclovir prophylaxis is limited by high cost. Our objective is to determine the burden and cost of treatment for CMV reactivation/disease among KT recipients who received ATG in Thailand since its first use in our center. We conducted a single-center retrospective cohort study of KT patients who received ATG during 2010-2013. We reviewed patients' characteristics, type of CMV prophylaxis, incidence of CMV reactivation, and outcome (co-infections, graft function and death). We compared the treatment cost between patients with and without CMV reactivation. Thirty patients included in the study had CMV serostatus D+/R+. Twenty-nine patients received intravenous ganciclovir early after KT as inpatients. Only three received outpatient valganciclovir prophylaxis. Incidence of CMV reactivation was 43%, with a median onset of 91 (range 23-1007) days after KT. Three patients had CMV end-organ disease; enterocolitis or retinitis. Infectious complication rate among ATG-treated KT patients was up to 83%, with a trend toward a higher rate among those with CMV reactivation ( = 0.087). Patients with CMV reactivation/disease required longer duration of hospitalization ( = 0.018). The rate of graft loss was 17%. The survival rate was 97%. The cost of treatment among patients with CMV reactivation was significantly higher for both inpatient setting ( = 0.021) and total cost ( = 0.035) than in those without CMV reactivation. Burden of infectious complications among ATG-treated KT patients was high. CMV reactivation is common and associated with longer duration of hospitalization and higher cost.
巨细胞病毒（CMV）是肾移植（KT）后感染并发症的重要原因，尤其是在接受抗胸腺细胞球蛋白（ATG）的患者中。CMV感染可导致器官功能障碍以及诸如移植排斥、移植失败和机会性感染等间接影响。CMV再激活的预防包括抢先或预防性方法。缬更昔洛韦预防的使用因成本高而受限。我们的目标是确定自ATG在我们中心首次使用以来，泰国接受ATG的KT受者中CMV再激活/疾病的治疗负担和成本。我们对2010年至2013年期间接受ATG的KT患者进行了一项单中心回顾性队列研究。我们回顾了患者的特征、CMV预防类型、CMV再激活的发生率以及结局（合并感染、移植功能和死亡）。我们比较了有和没有CMV再激活的患者之间的治疗成本。该研究纳入的30例患者CMV血清学状态为D+/R+。29例患者在KT后早期作为住院患者接受了静脉注射更昔洛韦。只有3例接受了门诊缬更昔洛韦预防。CMV再激活的发生率为43%，中位发病时间为KT后91天（范围23 - 1007天）。3例患者患有CMV终末器官疾病；小肠结肠炎或视网膜炎。接受ATG治疗的KT患者的感染并发症发生率高达83%，CMV再激活患者的发生率有升高趋势（P = 0.087）。CMV再激活/疾病患者需要更长的住院时间（P = 0.018）。移植丢失率为17%。生存率为97 %。CMV再激活患者的住院治疗成本（P = 0.021）和总成本（P = 0.035）均显著高于无CMV再激活的患者。接受ATG治疗的KT患者的感染并发症负担很高。CMV再激活很常见，且与更长的住院时间和更高的成本相关。
