在墨西哥城一家三级保健中心，采用抢先治疗策略管理的血清阳性肝移植受者中巨细胞病毒病的发生率和病毒复制动力学：一项回顾性队列研究。
Incidence of Cytomegalovirus disease and viral replication kinetics in seropositive liver transplant recipients managed under preemptive therapy in a tertiary-care center in Mexico City: a retrospective cohort study.
机构信息
Infectious Diseases Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Vasco de Quiroga 15, Belisario Domínguez Sección XVI, Tlalpan, 14080, Mexico City, Mexico.
Gastroenterology Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Vasco de Quiroga 15, Belisario Domínguez Sección XVI, Tlalpan, 14080, Mexico City, Mexico.
出版信息
BMC Infect Dis. 2022 Feb 14;22(1):155. doi: 10.1186/s12879-022-07123-w.
BACKGROUND
In the absence of an adequate prevention strategy, up to 20% of CMV IgG+ liver transplant recipients (LTR) will develop CMV disease. Despite improved reporting in CMV-DNAemia, there is no consensus as to what the ideal CMV-DNAemia cutoff for a successful preemptive strategy is. Each transplant centre establishes their own threshold. We aimed to determine the effectiveness of our preventive strategy in CMV IgG+ LTR, and evaluate CMV replication kinetics.
METHODS
In this retrospective study we determined the incidence of CMV disease in the first 6 months following transplantation in CMV seropositive LTR in a tertiary-care centre in Mexico. Secondary outcomes were determining the number of patients who required preemptive therapy (treatment cutoff ≥ 4000 UI/ml), adherence to the centre's prevention protocol and calculation of viral replication kinetics.
RESULTS
One-hundred and twenty-four patients met inclusion criteria. Four patients (3.2%) developed CMV disease. Ninety-six (85%) had detectable DNAemia and 25 (22%) asymptomatic patients received preemptive therapy, none of them developed CMV disease. The highest viral loads were observed on the second posttransplant month. The number of viral load measurements decreased over time. Patients with DNAemia ≥ 4000 UI/ml had a faster viral load growth rate, shorter viral load duplication time, and higher basic reproductive number. Viral load growth rate and autoimmune hepatitis were associated with development of DNAemia ≥ 4000 UI/ml.
CONCLUSION
Cytomegalovirus disease occurred in 3.2% of the study subjects. Preemptive therapy using a threshold of CMV ≥ 4000 UI/ml was effective in reducing the incidence of end-organ disease. The viral replication parameters described in this population highlight the importance of frequent monitoring, a challenging feat for transplant programs in low- and middle-income countries.
背景
在缺乏有效预防策略的情况下，高达 20%的巨细胞病毒（CMV）IgG+肝移植受者（LTR）将发展为 CMV 疾病。尽管 CMV-DNA 血症的报告有所改善，但对于成功的预防性策略的理想 CMV-DNA 血症截断值仍没有共识。每个移植中心都制定了自己的阈值。我们旨在确定我们在 CMV IgG+LTR 中的预防策略的有效性，并评估 CMV 复制动力学。
方法
在这项回顾性研究中，我们在墨西哥的一家三级保健中心确定了 CMV 血清阳性 LTR 在移植后 6 个月内发生 CMV 疾病的发生率。次要结局是确定需要预防性治疗（治疗截止值≥4000 UI/ml）的患者数量、对中心预防方案的依从性以及计算病毒复制动力学。
结果
符合纳入标准的患者共有 124 名。4 名患者（3.2%）发生 CMV 疾病。96 名（85%）患者有可检测到的 DNA 血症，25 名（22%）无症状患者接受了预防性治疗，他们均未发生 CMV 疾病。在移植后第二个月观察到最高病毒载量。随着时间的推移，病毒载量测量的数量减少。DNA 血症≥4000 UI/ml 的患者病毒载量增长更快，病毒载量复制时间更短，基本繁殖数更高。病毒载量增长速度和自身免疫性肝炎与 DNA 血症≥4000 UI/ml 的发生有关。
结论
该研究人群中，CMV 疾病的发生率为 3.2%。使用 CMV≥4000 UI/ml 的阈值进行预防性治疗可有效降低终末器官疾病的发生率。在本研究人群中描述的病毒复制参数突出了频繁监测的重要性，这对于中低收入国家的移植项目来说是一项具有挑战性的壮举。
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