Ribeiro Rafaela V P, Samman Anas, Wang Aizhou, Wang Stella, Martinu Tereza, Keshavjee Shaf, Singer Lianne G, Kumar Deepali, Humar Atul, Cypel Marcelo
Latner Thoracic Research Laboratories, Toronto General Hospital Research Institute, University Health Network, Toronto, Ontario, Canada.
Biostatistics Research Unit, University Health Network, Toronto, Ontario, Canada.
JTCVS Open. 2023 Feb 22;14:590-601. doi: 10.1016/j.xjon.2023.02.008. eCollection 2023 Jun.
Cytomegalovirus infection after lung transplant is associated with increased morbidity and mortality. Inflammation, infection, and longer ischemic times are important risk factors for cytomegalovirus infection. Ex vivo lung perfusion has helped to successfully increase the use of high-risk donors over the last decade. However, the impact of ex vivo lung perfusion on post-transplant cytomegalovirus infection is unknown.
We performed a retrospective analysis of all adult lung transplant recipients from 2010 to 2020. The primary end point was comparison of cytomegalovirus viremia between patients who received ex vivo lung perfusion donor lungs and patients who received non-ex vivo lung perfusion donor lungs. Cytomegalovirus viremia was defined as cytomegalovirus viral load greater than 1000 IU/mL within 2 years post-transplant. Secondary end points were the time from lung transplant to cytomegalovirus viremia, peak cytomegalovirus viral load, and survival. Outcomes were also compared between the different donor recipient cytomegalovirus serostatus matching groups.
Included were 902 recipients of non-ex vivo lung perfusion lungs and 403 recipients of ex vivo lung perfusion lungs. There was no significant difference in the distribution of the cytomegalovirus serostatus matching groups. A total of 34.6% of patients in the non-ex vivo lung perfusion group developed cytomegalovirus viremia, as did 30.8% in the ex vivo lung perfusion group ( = .17). There was no difference in time to viremia, peak viral loads, or survival when comparing both groups. Likewise, all outcomes were comparable in the non-ex vivo lung perfusion and ex vivo lung perfusion groups within each serostatus matching group.
The practice of using more injured donor organs via ex vivo lung perfusion has not affected cytomegalovirus viremia rates and severity in lung transplant recipients in our center.
肺移植后巨细胞病毒感染与发病率和死亡率增加相关。炎症、感染和较长的缺血时间是巨细胞病毒感染的重要危险因素。在过去十年中，体外肺灌注有助于成功增加高危供体的使用。然而，体外肺灌注对移植后巨细胞病毒感染的影响尚不清楚。
我们对2010年至2020年所有成年肺移植受者进行了回顾性分析。主要终点是比较接受体外肺灌注供体肺的患者和接受非体外肺灌注供体肺的患者之间的巨细胞病毒血症情况。巨细胞病毒血症定义为移植后2年内巨细胞病毒病毒载量大于1000 IU/mL。次要终点是从肺移植到巨细胞病毒血症的时间、巨细胞病毒病毒载量峰值和生存率。还比较了不同供体-受者巨细胞病毒血清学状态匹配组之间的结果。
纳入了902例非体外肺灌注肺的受者和403例体外肺灌注肺的受者。巨细胞病毒血清学状态匹配组的分布没有显著差异。非体外肺灌注组中34.6%的患者发生了巨细胞病毒血症，体外肺灌注组中这一比例为30.8%（P = 0.17）。比较两组时，在发生病毒血症的时间、病毒载量峰值或生存率方面没有差异。同样，在每个血清学状态匹配组中，非体外肺灌注组和体外肺灌注组的所有结果都具有可比性。
通过体外肺灌注使用更多受损供体器官的做法并未影响我们中心肺移植受者的巨细胞病毒血症发生率和严重程度。
