Renal Transplant Unit, Department of Internal Medicine, Academic Medical Center, Amsterdam, The Netherlands.
Center for Experimental Molecular Medicine, Amsterdam University Medical Centers, location Academic Medical Center, Amsterdam, The Netherlands.
Transpl Int. 2020 Sep;33(9):1116-1127. doi: 10.1111/tri.13667. Epub 2020 Jul 4.
The impact of primary cytomegalovirus infection (pCMV) on renal allograft function and histology is controversial. We evaluated the influence on incidence of acute rejection, allograft loss, allograft function and interstitial fibrosis/tubular atrophy (IF/TA). Retrospective case-control study, recipients transplanted between 2000 and 2014. Risk of acute rejection and allograft loss for those who experienced pCMV infection compared with those who did not, within an exposure period of two months after transplantation. Besides, its influence on allograft function and histology at one to three years after transplantation. Of 113 recipients experienced pCMV infection, 306 remained CMV seronegative. pCMV infection in the exposure period could not be proven as increasing the risk for acute rejection [HR = 2.18 (95% CI 0.80-5.97) P = 0.13] or allograft loss [HR = 1.11 (95%CI 0.33-3.72) P = 0.87]. Combination of pCMV infection and acute rejection posed higher hazard for allograft loss than acute rejection alone [HR = 3.69 (95% CI 1.21-11.29) P = 0.02]. eGFR(MDRD) values did not significantly differ at years one [46 vs. 50], two [46 vs. 51] and three [46 vs. 52]. No association between pCMV infection and IF/TA could be demonstrated [OR = 2.15 (95%CI 0.73-6.29) P = 0.16]. pCMV infection was not proven to increase the risk for acute rejection or allograft loss. However, it increased the risk for rejection-associated allograft loss. In remaining functioning allografts, it was not significantly associated with decline in function nor with presence of IF/TA.
原发性巨细胞病毒感染 (pCMV) 对肾移植功能和组织学的影响存在争议。我们评估了其对急性排斥反应、移植物丢失、移植物功能和间质纤维化/肾小管萎缩 (IF/TA) 的发生率的影响。回顾性病例对照研究，2000 年至 2014 年间接受移植的患者。在移植后两个月的暴露期内，比较发生 pCMV 感染和未发生 pCMV 感染的患者发生急性排斥反应和移植物丢失的风险。此外，还评估了其在移植后 1 至 3 年内对移植物功能和组织学的影响。在 113 例发生 pCMV 感染的患者中，306 例仍为 CMV 阴性。在暴露期内，pCMV 感染不能证明会增加急性排斥反应的风险 [HR=2.18(95%CI 0.80-5.97)P=0.13] 或移植物丢失的风险 [HR=1.11(95%CI 0.33-3.72)P=0.87]。pCMV 感染与急性排斥反应的组合比单独急性排斥反应对移植物丢失的危害更高 [HR=3.69(95%CI 1.21-11.29)P=0.02]。1 年时 [46 与 50]、2 年时 [46 与 51] 和 3 年时 [46 与 52] 的 eGFR(MDRD) 值无显著差异。pCMV 感染与 IF/TA 之间无相关性 [OR=2.15(95%CI 0.73-6.29)P=0.16]。pCMV 感染不能证明会增加急性排斥反应或移植物丢失的风险。然而，它增加了因排斥反应导致的移植物丢失的风险。在功能仍保留的移植物中，它与功能下降或 IF/TA 的发生无显著相关性。
