Cardiovascular and Thoracic Department, Division of Respiratory Diseases, University of Turin, Città della Salute e della Scienza di Torino, Torino, Italy.
Cardiovascular and Thoracic Department, Division of Respiratory Diseases, University of Turin, Città della Salute e della Scienza di Torino, C.so Bramante 88/90, Torino, 10126, Italy.
Ther Adv Respir Dis. 2019 Jan-Dec;13:1753466619878555. doi: 10.1177/1753466619878555.
There is no univocal prophylactic regimen to prevent cytomegalovirus (CMV) infection/disease in lung transplantation (LT) recipients. The aim of this study is to evaluate short-term clinical outcomes of a tailored combined CMV management approach.
After 1-year follow up, 43 LT patients receiving combined CMV prophylaxis with antiviral agents and CMV-specific IgG were evaluated in a retrospective observational study. Systemic and lung viral infections were investigated by molecular methods on a total of 1134 whole blood and 167 bronchoalveolar lavage (BAL) and biopsy specimens. CMV immunity was assessed by ELISPOT assay. Clinical and therapeutic data were also evaluated.
We found 2/167 cases of CMV pneumonia (1.2%), both in the donor-positive/recipient-positive (D/R) population, and 51/167 cases of CMV pulmonary infection (BAL positivity 30.5%). However, only 32/167 patients (19.1%) were treated due to their weak immunological response at CMV ELISPOT assay. Viremia ⩾100,000 copies/mL occurred in 33/1134 specimens (2.9%). Regarding CMV-serological matching (D/R), the D/R population had more CMV viremia episodes ( < 0.05) and fewer viremia-free days ( < 0.001).
Compared to previous findings, our study shows a lower incidence of CMV pneumonia and viremia despite the presence of a substantial CMV load. In addition, our findings further confirm the D/R group to be a high-risk population for CMV viremia. Overall, a good immunological response seems to protect patients from CMV viremia and pneumonia but not from CMV alveolar replication.
目前尚无明确的预防方案可用于预防肺移植（LT）受者的巨细胞病毒（CMV）感染/疾病。本研究旨在评估定制的 CMV 联合管理方法的短期临床结果。
在为期 1 年的随访后，对 43 例接受抗病毒药物和 CMV 特异性 IgG 联合 CMV 预防的 LT 患者进行回顾性观察研究。通过分子方法对总共 1134 份全血和 167 份支气管肺泡灌洗液（BAL）和活检标本进行全身和肺部病毒感染检测。通过 ELISPOT 测定评估 CMV 免疫。还评估了临床和治疗数据。
我们发现 2/167 例（1.2%）CMV 肺炎发生于供体阳性/受体阳性（D/R）人群，51/167 例（30.5%）CMV 肺部感染发生于 BAL 阳性患者。然而，只有 32/167 例（19.1%）患者由于 CMV ELISPOT 检测呈弱免疫反应而接受治疗。在 1134 份标本中，有 33 份（2.9%）出现病毒载量 ⩾100,000 拷贝/ml。关于 CMV 血清学匹配（D/R），D/R 人群的 CMV 病毒血症发作次数更多（ < 0.05），病毒血症无发作天数更少（ < 0.001）。
与之前的研究结果相比，尽管存在大量 CMV 负荷，本研究显示 CMV 肺炎和病毒血症的发生率较低。此外，我们的研究结果进一步证实 D/R 组是 CMV 病毒血症的高危人群。总的来说，良好的免疫反应似乎可以保护患者免受 CMV 病毒血症和肺炎的侵害，但不能免受 CMV 肺泡复制的侵害。
