Department of Medicine, University of Alberta, Edmonton, Alberta, Canada.
Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
Clin Infect Dis. 2021 Mar 1;72(5):845-852. doi: 10.1093/cid/ciaa125.
Cytomegalovirus (CMV) is the most common opportunistic pathogen, following solid organ transplantation (SOT), that leads to direct and indirect effects. The aim of this study was to assess the impact of CMV exposure at transplantation on the rate of posttransplant thrombotic events (TEs).
We conducted a retrospective cohort study of patients transplanted at the University of Alberta Hospital between July 2005 and January 2018. We included adult SOT CMV-seronegative recipients at transplantation who received an allograft from either a seropositive donor (D+/R-) or a seronegative donor (D-/R-).
A total of 392 SOT recipients were included: 151 (39%) liver, 188 (48%) kidney, 45 (11%) pancreas, and 8 (2%) other transplants. The mean age was 47 years, 297 (76%) were males, and 181 (46%) had a CMV D+/R- donor. Patients in the CMV D+/R- cohort were slightly older (51 years versus 48 years in the D-/R- cohort; P = .036), while other variables, including cardiovascular risk factors and pretransplant TEs, were not different between groups. Overall, TEs occurred in 35 (19%) patients in the CMV D+/R- group, versus 21 (10%) in the CMV D-/R- group, at 5 years of follow-up (P = .008); the incidence rates per 100 transplant months were 5.12 and 1.02 in the CMV D+/R- and CMV D-/R- groups, respectively (P = .003). After adjusting for potential confounders with a Cox regression model, a CMV D+/R- transplantation was independently associated with an increased risk of a TE over 5 years (adjusted hazard ratio, 3.027; 95% confidence interval, 1.669-5.488).
A CMV D+/R- transplantation is associated with an increased risk of a TE posttransplantation.
巨细胞病毒（CMV）是实体器官移植（SOT）后导致直接和间接影响的最常见机会性病原体。本研究旨在评估移植时 CMV 暴露对移植后血栓形成事件（TEs）发生率的影响。
我们对 2005 年 7 月至 2018 年 1 月在阿尔伯塔大学医院接受移植的患者进行了回顾性队列研究。我们纳入了移植时 CMV 血清阴性的成年 SOT 受者，他们接受了来自血清阳性供体（D+/R-）或血清阴性供体（D-/R-）的同种异体移植物。
共纳入 392 例 SOT 受者：151 例（39%）为肝移植，188 例（48%）为肾移植，45 例（11%）为胰腺移植，8 例（2%）为其他移植。平均年龄为 47 岁，297 例（76%）为男性，181 例（46%）有 CMV D+/R-供体。CMV D+/R-组患者年龄稍大（51 岁 vs. D-/R-组 48 岁；P=0.036），而其他变量，包括心血管危险因素和移植前 TEs，两组间无差异。总体而言，CMV D+/R-组有 35 例（19%）患者发生 TEs，而 CMV D-/R-组有 21 例（10%）患者发生 TEs，在 5 年随访中（P=0.008）；CMV D+/R-组和 CMV D-/R-组每 100 个移植月的发生率分别为 5.12 和 1.02（P=0.003）。使用 Cox 回归模型调整潜在混杂因素后，CMV D+/R-移植与 5 年内 TEs 的发生风险增加独立相关（调整后的危险比，3.027；95%置信区间，1.669-5.488）。
CMV D+/R-移植与移植后 TEs 的发生风险增加相关。
