Jehn Ulrich, Schütte-Nütgen Katharina, Bautz Joachim, Pavenstädt Hermann, Suwelack Barbara, Thölking Gerold, Heinzow Hauke, Reuter Stefan
Department of Medicine D, Division of General Internal Medicine, Nephrology and Rheumatology, University Hospital of Muenster, 48149 Muenster, Germany.
Department of Medicine B, Division of Gastroenterology and Hepatology, University Hospital of Muenster, 48149 Muenster, Germany.
J Clin Med. 2020 Jan 17;9(1):252. doi: 10.3390/jcm9010252.
Despite screening, effective anti-viral drugs and risk-balanced prophylaxis, cytomegalovirus (CMV) remains a major cause of morbidity in transplant patients. The objective of this study was to retrospectively analyze the risk factors associated with CMV viremia after kidney transplantation in a large European cohort with standardized valganciclovir prophylaxis in the present era. A special focus was placed on the comparison of living and postmortal donation. We conducted a longitudinal observational study involving 723 adult patients with a total of 3292 patient-years who were transplanted at our center between 2007 and 2015. Valganciclovir prophylaxis was administered over 100 days for CMV+ donors (D) or recipients (R), over 200 days for D+/R-, and none in D-/R-. A CMV+ donor, rejection episodes, and deceased donor transplantation were identified to be associated with increased incidences of CMV viremia. Although we did not find a reduced overall survival rate for patients with CMV viremia, it was associated with worse graft function. Since we observed a relevant number of CMV infections despite prescribing valganciclovir prophylaxis, a pre-emptive strategy in patients with (suspected) adherence restrictions could be favored. Our data can help transplant physicians educate their patients about their individual CMV risk and choose the most appropriate CMV treatment approach.
尽管有筛查、有效的抗病毒药物和风险平衡的预防措施，但巨细胞病毒（CMV）仍是移植患者发病的主要原因。本研究的目的是回顾性分析当代欧洲一个大型队列中接受标准化缬更昔洛韦预防的肾移植受者中与CMV病毒血症相关的危险因素。特别关注活体供肾和尸检供肾的比较。我们进行了一项纵向观察性研究，纳入了723例成年患者，共3292患者年，这些患者于2007年至2015年在我们中心接受移植。对于CMV阳性供者（D）或受者（R），缬更昔洛韦预防用药100天；对于D+/R-，用药200天；对于D-/R-，则不进行预防。CMV阳性供者、排斥反应发作和尸检供肾移植被确定与CMV病毒血症发生率增加有关。虽然我们没有发现CMV病毒血症患者的总生存率降低，但它与移植肾功能较差有关。由于尽管使用了缬更昔洛韦预防，我们仍观察到相当数量的CMV感染，因此对于有（疑似）依从性限制的患者，优先采用抢先治疗策略可能是有利的。我们的数据可以帮助移植医生向患者宣传其个体CMV风险，并选择最合适的CMV治疗方法。
