Department of Infectious Diseases, Alfred Health and Central Clinical School, Monash University, Melbourne, Victoria, Australia.
Pharmacy Department, Alfred Health, Melbourne, Victoria, Australia.
Clin Transplant. 2023 Jun;37(6):e14982. doi: 10.1111/ctr.14982. Epub 2023 Mar 29.
The frequency and significance of cytomegalovirus (CMV) infection in seropositive (R+) heart transplant recipients (HTR) is unclear, with preventative recommendations mostly extrapolated from other groups. We evaluated the incidence and severity of CMV infection in R+ HTR, to identify risk factors and describe outcomes.
R+ HTR from 2010 to 2019 were included. Antiviral prophylaxis was not routinely used, with clinically guided monitoring the local standard of care. The primary outcome was CMV infection within one-year post-transplant; secondary outcomes included other herpesvirus infections and mortality.
CMV infection occurred in 27/155 (17%) R+ HTR. Patients with CMV had a longer hospitalization (27 vs. 20 days, unadjusted HR 1.02, 95% CI 1.00-1.02, p = .01), higher rate of intensive care readmission (26% vs. 9%, unadjusted HR 3.46, 1.46-8.20, p = .005), and increased mortality (33% vs. 8%, unadjusted HR 10.60, 4.52-24.88, p < .001). The association between CMV and death persisted after adjusting for multiple confounders (HR 24.19, 95% CI 7.47-78.30, p < .001). Valganciclovir prophylaxis was used in 35/155 (23%) and was protective against CMV (infection rate 4% vs. 27%, adjusted HR .07, .01-.72, p = .025), even though those receiving it were more likely to have received thymoglobulin (adjusted OR 10.5, 95% CI 2.01-55.0, p = .005).
CMV infection is common in R+ HTR and is associated with a high burden of disease and increased mortality. Patients who received valganciclovir prophylaxis were less likely to develop CMV infection, despite being at higher risk. These findings support the routine use of antiviral prophylaxis following heart transplantation in all CMV R+ patients.
巨细胞病毒（CMV）感染在血清阳性（R+）心脏移植受者（HTR）中的频率和意义尚不清楚，预防建议大多是从其他群体推断而来。我们评估了 R+ HTR 中 CMV 感染的发生率和严重程度，以确定危险因素并描述结局。
纳入 2010 年至 2019 年的 R+ HTR。抗病毒预防用药并非常规使用，而是采用临床指导下的监测作为当地的标准治疗。主要结局是移植后一年内的 CMV 感染；次要结局包括其他疱疹病毒感染和死亡率。
27/155（17%）例 R+ HTR 发生 CMV 感染。CMV 感染者的住院时间更长（27 天 vs. 20 天，未调整 HR 1.02，95%CI 1.00-1.02，p=0.01），重症监护病房再入院率更高（26% vs. 9%，未调整 HR 3.46，1.46-8.20，p=0.005），死亡率增加（33% vs. 8%，未调整 HR 10.60，4.52-24.88，p<0.001）。在调整了多个混杂因素后，CMV 与死亡之间的关联仍然存在（HR 24.19，95%CI 7.47-78.30，p<0.001）。155 例患者中有 35 例（23%）接受缬更昔洛韦预防用药，且可预防 CMV（感染率为 4% vs. 27%，调整 HR 0.07，0.01-0.72，p=0.025），尽管接受预防用药者更有可能接受了胸腺球蛋白（调整 OR 10.5，95%CI 2.01-55.0，p=0.005）。
CMV 感染在 R+ HTR 中很常见，与疾病负担增加和死亡率升高有关。尽管风险较高，但接受缬更昔洛韦预防用药的患者发生 CMV 感染的可能性较小。这些发现支持在所有 CMV R+患者中常规使用抗病毒预防用药。
