Department of Paediatrics and Child Health, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
Paediatric Gastroenterology and Hepatology Unit, Charlotte Maxeke Johannesburg Hospital, University of Witwatersrand, Johannesburg, South Africa.
Transpl Infect Dis. 2022 Dec;24(6):e13917. doi: 10.1111/tid.13917. Epub 2022 Jul 29.
Cytomegalovirus (CMV) infection and disease are preventable complications following pediatric liver transplantation (PLT), despite the use of prophylaxis to minimize the risk of CMV disease. We evaluated the incidence and complications of CMV disease in PLT recipients in South Africa (SA), with particular reference to potential differences in outcome between state and private sector patients.
Medical records of patients younger than 16 years of age who received liver transplants between January 1, 2012, and August 31, 2018 were analyzed.
Records of all 150 PLT patients were retrieved. The median age at transplant was 29.2 months (95% confidence interval 15.6-58.4) and follow-up was 46.3 months (interquartile range 27.6-63.1). Sixty-six (44%) patients were high risk, 79 (52.7%) were intermediate risk, and five (3.3%) were low risk for CMV infection. Forty-three (28.9%) patients had CMV DNAemia following transplantation, and 30 (20.1%) developed CMV disease. Receipt of care in the private sector was consistently associated with a lower hazard of CMV disease (adjusted hazard ratio [aHR] ranging from 0.36 to 0.43) and a consistently lower hazard of death among recipients at high risk for CMV disease and/or those who developed CMV disease (aHR ranging from 0.28 to 0.33).
Receipt of care in the private health sector was associated with a consistently lower hazard of CMV disease and death in individuals with CMV disease and/or at high risk for CMV disease. Policies aimed at creating a more equitable healthcare system in SA may mitigate the differential burden of illness associated with CMV in PLT recipients.
尽管采用了预防措施来最大程度地降低巨细胞病毒（CMV）疾病的风险，但小儿肝移植（PLT）后 CMV 感染和疾病仍是可预防的并发症。我们评估了南非（SA）PLT 受者中 CMV 疾病的发生率和并发症，特别关注州立和私营部门患者之间潜在的结局差异。
分析了 2012 年 1 月 1 日至 2018 年 8 月 31 日期间接受肝移植的年龄小于 16 岁的患者的病历。
共检索到 150 例 PLT 患者的记录。移植时的中位年龄为 29.2 个月（95%置信区间 15.6-58.4），随访时间为 46.3 个月（四分位距 27.6-63.1）。66 例（44%）患者为 CMV 感染高风险，79 例（52.7%）为中风险，5 例（3.3%）为低风险。43 例（28.9%）患者在移植后出现 CMV DNA 血症，30 例（20.1%）发生 CMV 疾病。在私营部门接受治疗与 CMV 疾病的发生风险降低相关（调整后的危险比[aHR]范围为 0.36 至 0.43），且高风险 CMV 疾病患者和/或发生 CMV 疾病患者的死亡率降低（aHR 范围为 0.28 至 0.33）。
在私营医疗部门接受治疗与 CMV 疾病和死亡的风险降低相关，包括 CMV 疾病患者和/或高风险 CMV 疾病患者。旨在建立一个更公平的医疗保健系统的政策可能会减轻与 PLT 受者 CMV 相关的疾病差异负担。
