Department of Immunopathology, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
Department of Immunopathology, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
Transplant Proc. 2020 Dec;52(10):3173-3178. doi: 10.1016/j.transproceed.2020.02.162. Epub 2020 Jul 2.
Cytomegalovirus (CMV) reactivation or infection is one of the most important infectious complications in transplant recipient leading to significant morbidity and mortality. Its early detection and prompt treatment is imperative to improve transplant outcome. The present study estimated the frequency of CMV in renal transplant recipients (RTR). Various aspects of pp65Ag assay and quantitative real-time polymerase chain reaction (qRT-PCR) were evaluated in relation to the recent guidelines for CMV detection and treatment.
Retrospectively, data of clinically suspected cases of CMV (1610 out of total 2681 renal transplants) were analyzed along with a comparison of pp65Ag assay and qRT-PCR.
The overall incidence of CMV syndrome was 14.25%; however, the incidence of CMV viremia in the clinically suspected group was 23.73%. The proportion of positive cases with pp65Ag assay and qRT-PCR were 13.6% (95% CI; 7.9-22.3) and 19.3% (95% CI; 12.4-28.8) with a substantial agreement (Cohen's kappa = 0.632) between the 2 techniques. CMV positive recipients were treated with ganciclovir until their viral count was negative or up to 3 weeks, followed by 3 months of prophylaxis with valganciclovir. No graft failure or mortality was reported secondary to CMV infection until 3 to 5 years of follow-up.
CMV infection is quite prevalent in RTR, and early detection and immediate treatment or prophylaxis is of utmost importance. qRT-PCR is the gold standard and preferred over other methods; however pp65Ag assay still holds its importance in low-economic countries and populations where CMV infection is more prevalent and financial constraints are a major limitation.
巨细胞病毒（CMV）再激活或感染是移植受者最重要的感染性并发症之一，导致发病率和死亡率显著增加。早期发现和及时治疗对于改善移植结果至关重要。本研究估计了肾移植受者（RTR）中 CMV 的频率。评估了 pp65Ag 检测和定量实时聚合酶链反应（qRT-PCR）在 CMV 检测和治疗新指南方面的各个方面。
回顾性分析了临床疑似 CMV 病例（2681 例肾移植中有 1610 例）的数据，并与 pp65Ag 检测和 qRT-PCR 进行了比较。
CMV 综合征的总发生率为 14.25%；然而，临床疑似组 CMV 病毒血症的发生率为 23.73%。pp65Ag 检测和 qRT-PCR 的阳性病例比例分别为 13.6%（95%CI；7.9-22.3）和 19.3%（95%CI；12.4-28.8），两种技术之间具有高度一致性（Cohen's kappa = 0.632）。CMV 阳性受者接受更昔洛韦治疗，直到病毒载量转为阴性或持续 3 周，然后用缬更昔洛韦进行 3 个月的预防治疗。在 3 至 5 年的随访中，没有因 CMV 感染导致移植物失功或死亡。
CMV 感染在 RTR 中相当普遍，早期发现和及时治疗或预防至关重要。qRT-PCR 是金标准，优于其他方法；然而，pp65Ag 检测在 CMV 感染更为普遍且经济限制是主要限制的经济欠发达国家和人群中仍然具有重要意义。
