Division of Nephrology, Oregon Health and Science University, Portland, Oregon, USA.
Section of Nephrology, VA Medical Center, Portland, Oregon, USA.
Am J Transplant. 2020 Dec;20(12):3502-3508. doi: 10.1111/ajt.15976. Epub 2020 Jun 23.
Cytomegalovirus (CMV) is a major cause of infection-related morbidity and mortality in kidney transplantation. The most significant risk for developing CMV infection after transplant depends upon donor (D) and recipient (R) CMV serostatus. In 2012, our Organ Procurement Organization (OPO) began a novel pretransplant CMV prevention strategy via matching deceased kidney donors and recipients by CMV serostatus. Prior to the matching protocol, our distribution of seropositive and seronegative donors and recipients was similar to the United States at large. After the matching protocol, high-risk D+R- were reduced from 18.5% to 2.9%, whereas low-risk D-R- were increased from 13.5% to 24%. There was no adverse effect on transplant rates and no differential effect on waiting times for R+ vs R- after the protocol was implemented. This protocol could be implemented on a regional or national level to optimize low and high-risk CMV seroprofiles and potentially improve CMV-related outcomes in kidney transplantation.
巨细胞病毒（CMV）是肾移植后与感染相关的发病率和死亡率的主要原因。移植后发生 CMV 感染的最大风险取决于供体（D）和受体（R）的 CMV 血清状态。2012 年，我们的器官获取组织（OPO）开始通过 CMV 血清状态匹配死亡肾供体和受体，制定了一种新的移植前 CMV 预防策略。在匹配方案之前，我们的血清阳性和血清阴性供体和受体的分布与美国大致相似。在匹配方案之后，高风险的 D+R-从 18.5%降至 2.9%，而低风险的 D-R-从 13.5%增加到 24%。实施该方案后，并未对移植率产生不利影响，也未对 R+与 R-的等待时间产生差异影响。该方案可在区域或国家层面实施，以优化低风险和高风险 CMV 血清学特征，并可能改善肾移植中与 CMV 相关的结局。
