College of Medicine and Health Sciences, University of Toledo, Toledo, OH, United States of America.
College of Medicine and Health Sciences, University of Toledo, Toledo, OH, United States of America.
Transpl Immunol. 2019 Oct;56:101226. doi: 10.1016/j.trim.2019.101226. Epub 2019 Jul 22.
Alemtuzumab (Ale) is a recombinant monoclonal antibody which binds to CD52 causing profound lymphodepletion, thus allowing its use in renal transplantation induction therapy. However, patients may be at increased risk for opportunistic infections, such as Cytomegalovirus (CMV). We analyzed CMV infection in renal allograft recipients administered low-dose valganciclovir (VGCV) prophylaxis with alemtuzumab induction and steroid minimization.
In this retrospective analysis, 678 kidney transplant recipients were evaluated, with 606 included for analysis. Patients were excluded for receiving induction therapy other than Ale, or for lack of follow-up within 1 year. VGCV prophylaxis was stratified by recipient CMV risk status and low-dose (450 mg) VGCV was given 3 times a week to low and moderate risk patients and daily to high risk individuals. Subject records were examined for recipient demographics, donor and recipient CMV serostatus, CMV viremia, and invasive infection.
Of the 606 recipients, 154 were defined as low risk for CMV infection (donor and recipient both negative, or D-/R-), 236 as moderate risk without mismatch (D+/R+), 122 as moderate risk with mismatch (D-/R+), and 94 as high risk (D+/R-). Twenty-nine (29) individuals (4.8%) tested positive by PCR for CMV viremia and 10 (1.7%) patients developed invasive CMV disease, including colitis (n = 4), esophagitis (n = 1), enteritis (n = 1), nephritis (n = 1), and pneumonia (n = 3). High risk recipients (D+/R-) accounted for the majority of invasive CMV disease (n = 5), followed by moderate risk (n = 4). CMV viremia was also more common in high risk and moderate risk (D+/R+) individuals. Overall rejection rate for our study population was 27%.
In this institution's experience, CMV incidence was reduced compared to historically reported data by using low-dose (450 mg) VGCV prophylaxis in combination with Ale induction and steroid minimization. However, overall rejection rate was significantly higher in our population, possibly influenced by the degree of steroid minimization.
阿仑单抗（Ale）是一种重组单克隆抗体，可与 CD52 结合，导致严重的淋巴细胞耗竭，从而使其可用于肾移植诱导治疗。然而，患者可能有更高的机会感染机会性感染，如巨细胞病毒（CMV）。我们分析了接受低剂量缬更昔洛韦（VGCV）预防、阿仑单抗诱导和类固醇最小化治疗的肾移植受者的 CMV 感染。
在这项回顾性分析中，评估了 678 例接受肾移植的患者，其中 606 例纳入分析。接受阿仑单抗以外的诱导治疗或在 1 年内缺乏随访的患者被排除在外。根据受者 CMV 风险状况对 VGCV 预防进行分层，低危和中危患者每周接受 3 次 450mg VGCV，高危患者每日接受 VGCV。检查受者的记录，包括受者的人口统计学、供者和受者的 CMV 血清学状态、CMV 病毒血症和侵袭性感染。
606 例受者中，154 例被定义为 CMV 感染低危（供者和受者均为阴性，或 D-/R-），236 例为无错配的中危（D+/R+），122 例为有错配的中危（D-/R+），94 例为高危（D+/R-）。29 例（4.8%）患者的 CMV 病毒血症 PCR 检测呈阳性，10 例（1.7%）患者发生侵袭性 CMV 疾病，包括结肠炎（n=4）、食管炎（n=1）、肠炎（n=1）、肾炎（n=1）和肺炎（n=3）。高危受者（D+/R-）占侵袭性 CMV 疾病的大多数（n=5），其次是中危受者（n=4）。高危和中危（D+/R+）受者的 CMV 病毒血症也更为常见。本研究人群的总体排斥率为 27%。
在本机构的经验中，与历史报告数据相比，通过使用低剂量（450mg）VGCV 预防联合阿仑单抗诱导和类固醇最小化，CMV 的发生率降低。然而，我们人群的总体排斥率显著更高，这可能受到类固醇最小化程度的影响。
