Yim Seung Hyuk, Choi Mun Chae, Kim Deok-Gie, Min Eun-Ki, Lee Jae Geun, Joo Dong Jin, Kim Myoung Soo
Department of Surgery, The Research Institute for Transplantation, Yonsei University College of Medicine, Seoul 03722, Republic of Korea.
Pathogens. 2023 Mar 27;12(4):521. doi: 10.3390/pathogens12040521.
Cytomegalovirus (CMV), a common pathogen, causes infectious complications and affects long-term survival after transplantation. Studies examining living donor liver transplantation (LDLT) are limited. This study analyzed the risk factors for CMV infection and its impact on the survival of LDLT patients. A nested case-control design retrospectively analyzed data from 952 patients who underwent LDLT from 2005-2021. The incidence of CMV infection for the study cohort was 15.2% at 3 months for LDLT patients managed preemptively. Patients with CMV infections were matched with those without the infection at corresponding time points (index postoperative day) in a 1:2 ratio. Graft survival was significantly lower in the CMV infection group than in the control group. CMV infection was an independent risk factor for graft survival in the matched cohort (HR 1.93, = 0.012). Independent risk factors for CMV infection were female sex (HR 2.4, = 0.003), pretransplant MELD (HR 1.06, = 0.004), pretransplant in-hospital stay (HR 1.83, = 0.030), ABO incompatibility (HR 2.10, = 0.009), donor macrovesicular steatosis ≥10% (HR 2.01, = 0.030), and re-operation before index POD (HR 2.51, = 0.035). CMV infection is an independent survival risk factor, and its risk factors should be included in the surveillance and treatment of CMV infections after LDLT.
巨细胞病毒（CMV）是一种常见病原体，可导致感染性并发症，并影响移植后的长期生存。关于活体肝移植（LDLT）的研究有限。本研究分析了CMV感染的危险因素及其对LDLT患者生存的影响。采用巢式病例对照设计，回顾性分析了2005年至2021年接受LDLT的952例患者的数据。对于接受抢先治疗的LDLT患者，研究队列中CMV感染的发生率在3个月时为15.2%。CMV感染患者与未感染患者在相应时间点（术后索引日）按1:2的比例进行匹配。CMV感染组的移植物存活率显著低于对照组。在匹配队列中，CMV感染是移植物存活的独立危险因素（HR 1.93，P = 0.012）。CMV感染的独立危险因素包括女性（HR 2.4，P = 0.003）、移植前终末期肝病模型（MELD）评分（HR 1.06，P = 0.004）、移植前住院时间（HR 1.83，P = 0.030）、ABO血型不相容（HR 2.10，P = 0.009）、供体大泡性脂肪变性≥10%（HR 2.01，P = 0.030）以及索引术后日之前再次手术（HR 2.51，P = 0.035）。CMV感染是一个独立的生存危险因素，其危险因素应纳入LDLT术后CMV感染的监测和治疗中。
