Wulff Signe Marie, Perch Michael, Helweg-Larsen Jannik, Bredahl Pia, Arendrup Maiken Cavling, Lundgren Jens, Helleberg Marie, Crone Cornelia Geisler
Centre of Excellence for Health, Immunity and Infections (CHIP), Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.
Department of Cardiology, Section for Lung Transplantation, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.
APMIS. 2023 Nov;131(11):574-583. doi: 10.1111/apm.13317. Epub 2023 Apr 24.
Cytomegalovirus (CMV) and invasive aspergillosis (IA) cause morbidity among lung transplant recipients (LTXr). Early diagnosis and treatment could improve outcomes. We examined rates of CMV after IA and vice versa to assess whether screening for one infection is warranted after detecting the other. All Danish LTXr, 2010-2019, were followed for IA and CMV for 2 years after transplantation. IA was defined using ISHLT criteria. Adjusted incidence rate ratios (aIRR) were estimated by Poisson regression adjusted for time after transplantation. We included 295 LTXr, among whom CMV and IA were diagnosed in 128 (43%) and 48 (16%). The risk of CMV was high the first 3 months after IA, IR 98/100 person-years of follow-up (95% CI 47-206). The risk of IA was significantly increased in the first 3 months after CMV, aIRR 2.91 (95% CI 1.32-6.44). Numbers needed to screen to diagnose one case of CMV after IA, and one case of IA after CMV was approximately seven and eight, respectively. Systematic screening for CMV following diagnosis of IA, and vice versa, may improve timeliness of diagnosis and outcomes for LTXr.
巨细胞病毒（CMV）和侵袭性曲霉病（IA）可导致肺移植受者（LTXr）发病。早期诊断和治疗可改善预后。我们研究了IA后CMV的发生率，反之亦然，以评估在检测到另一种感染后是否有必要对一种感染进行筛查。对2010 - 2019年所有丹麦LTXr在移植后2年进行IA和CMV随访。IA根据国际心脏和肺移植学会（ISHLT）标准定义。通过对移植后时间进行校正的泊松回归估计校正发病率比（aIRR）。我们纳入了295例LTXr，其中128例（43%）诊断为CMV，48例（16%）诊断为IA。IA后前3个月CMV风险较高，随访期间发病率为98/100人年（95%可信区间47 - 206）。CMV后前3个月IA风险显著增加，aIRR为2.91（95%可信区间1.32 - 6.44）。IA后诊断1例CMV和CMV后诊断1例IA所需筛查人数分别约为7人和8人。IA诊断后系统筛查CMV，反之亦然，可能会提高LTXr的诊断及时性和预后。
