Division of Pulmonology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea.
Division of Infectious Diseases, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea.
Lung. 2020 Oct;198(5):829-838. doi: 10.1007/s00408-020-00380-z. Epub 2020 Jul 22.
We examined risk factors that may have contributed to Cytomegalovirus (CMV) reactivation among patients who underwent lung transplantation (LTx).
We reviewed medical records of patients who underwent LTx at a tertiary healthcare hospital in South Korea between January 2013 and May 2017. We excluded patients who died within the first year after LTx and those lost to follow-up. CMV reactivation was defined as the detection of CMV titers above 3000 copies/ml regardless of specific symptoms after prophylaxis cessation.
Of 89 patients included, 39 (43.8%) developed CMV reactivation. Of those 39 patients, 16 (41.0%) experienced additional CMV reactivation. Multivariate analysis identified lymphocyte counts below 1.0 × 10/μl (hazard ratio [HR] 49.33, p < 0.001) and use of steroids at more than twice the standard dose (HR 8.07, p < 0.001) as risk factors for CMV reactivation. The multivariate model also identified chronic kidney disease (CKD; HR 5.19, p = 0.016) and pneumonia (HR 17.22, p = 0.013) as risk factors for repetitive CMV reactivation.
This study suggests that lymphopenia and high doses of steroids may be important risk factors for CMV reactivation in LTx patients. Our results also suggest that repetitive CMV reactivation may be associated with CKD and pneumonia.
我们研究了导致接受肺移植（LTx）的患者巨细胞病毒（CMV）再激活的可能相关因素。
我们回顾了 2013 年 1 月至 2017 年 5 月期间在韩国一家三级保健医院接受 LTx 的患者的病历。我们排除了在 LTx 后一年内死亡和失访的患者。CMV 再激活定义为在预防措施停止后，无论是否有具体症状，CMV 滴度检测值超过 3000 拷贝/ml。
在 89 例患者中，39 例（43.8%）发生了 CMV 再激活。在这 39 例患者中，16 例（41.0%）发生了额外的 CMV 再激活。多变量分析发现，淋巴细胞计数低于 1.0×10/μl（风险比[HR] 49.33，p<0.001）和使用超过标准剂量两倍的类固醇（HR 8.07，p<0.001）是 CMV 再激活的危险因素。多变量模型还确定了慢性肾脏病（CKD；HR 5.19，p=0.016）和肺炎（HR 17.22，p=0.013）是重复 CMV 再激活的危险因素。
本研究表明，淋巴细胞减少和高剂量类固醇可能是 LTx 患者 CMV 再激活的重要危险因素。我们的结果还表明，重复的 CMV 再激活可能与 CKD 和肺炎有关。
