Division of Infectious Diseases, Duke University Medical Center, Durham, NC, USA.
Duke Clinical Research Institute, Durham, NC, USA.
Eur J Clin Microbiol Infect Dis. 2020 Mar;39(3):455-463. doi: 10.1007/s10096-019-03744-3. Epub 2019 Nov 22.
Evaluate risk factors for cytomegalovirus (CMV) reactivation during the first year after kidney transplantation in the CMV-seropositive older recipient. Retrospective single-center study. Between 2011 and 2015, 91 patients ≥ 65 years received a kidney transplant; these were matched with 91 controls, aged 40-60. Risk of CMV reactivation in the CMV-seropositive recipients was analyzed. Sixty-three older and 54 younger recipients were included; 50% had received CMV-directed prophylaxis. CMV reactivation was significantly more frequent in the older group (71.4% vs 44.4%, p = 0.003) and occurred earlier (p = 0.003). A multivariate model showed that only age was associated with CMV reactivation (OR 2.48, p = 0.03). After excluding patients that received thymoglobulin, older age group remained the only risk factor of CMV reactivation (OR 3.81, p = 0.014). Recurrent event analysis showed that the older cohort had an HR of 1.94 (p = 0.01) of CMV viremia; there was significant episode-cohort interaction (p < 0.01). While the older group had a higher risk of infection (HR = 2.43), after the initial episode the relative hazards were approximately equal (HR = 1.08, at period 2). This suggests that it is key to specifically avoid the first episode of reactivation. Universal prophylaxis or a hybrid prophylaxis model should be considered in the CMV-seropositive kidney transplant recipient aged ≥ 65 years.
评估巨细胞病毒（CMV）在 CMV 阳性老年受者肾移植后 1 年内再激活的危险因素。回顾性单中心研究。2011 年至 2015 年间，91 例年龄≥65 岁的患者接受了肾移植；这些患者与 91 例年龄 40-60 岁的对照组相匹配。分析 CMV 阳性受者 CMV 再激活的风险。纳入 63 例老年和 54 例年轻受者；50%接受了 CMV 定向预防。老年组 CMV 再激活发生率显著高于年轻组（71.4% vs 44.4%，p=0.003），且更早发生（p=0.003）。多变量模型显示，只有年龄与 CMV 再激活相关（OR 2.48，p=0.03）。排除使用胸腺球蛋白的患者后，老年组仍然是 CMV 再激活的唯一危险因素（OR 3.81，p=0.014）。复发事件分析显示，老年队列 CMV 血症的 HR 为 1.94（p=0.01）；存在显著的病例队列交互作用（p<0.01）。虽然老年组感染风险较高（HR=2.43），但在初次发作后，相对危险度大致相等（HR=1.08，在第 2 期）。这表明，关键是要特别避免初次再激活。对于 CMV 阳性肾移植受者，年龄≥65 岁时应考虑使用普遍预防或混合预防模型。
