Division of Infectious Diseases, The Warren Alpert Medical School of Brown University, Providence, Rhode Island, United States.
The Warren Alpert Medical School of Brown University, Providence, Rhode Island, United States.
Transplant Rev (Orlando). 2024 Dec;38(4):100860. doi: 10.1016/j.trre.2024.100860. Epub 2024 May 25.
Despite advancements in Cytomegalovirus (CMV) management, its impact on graft function, mortality, and cardiovascular (CV) health of organ transplant recipients (OTR) remains a significant concern. We investigated the association between CMV infection and CV events (CVE) in organ (other than heart) transplant recipients.
We conducted a comprehensive literature search in PubMed and EMBASE, including studies that reported on CMV infection or disease and post-transplantation CVE. Studies of heart transplant recipients were excluded.
We screened 3875 abstracts and 12 clinical studies were included in the final analysis, mainly in kidney and liver transplant recipients. A significant association was observed between CMV infection and an increased risk of CVE, with a pooled unadjusted hazard ratio (HR) of 1.99 (95% Confidence Intervals [CI] 1.45-2.73) for CMV infection and 1.59 (95% CI 1.21-2.10) for CMV disease. Pooled adjusted HR were 2.17 (95% CI 1.47-3.20) and 1.77 (95% CI 0.83-3.76), respectively. Heterogeneity was low (I = 0%) for CMV infection, suggesting consistent association across studies, and moderate-to-high for CMVdisease (I = 50% for unadjusted, 53% for adjusted HR).
We found a significant association between CMV infection and CV risk in abdominal OTR, underscoring the importance of proactive CMV surveillance and early treatment. Future research should aim for more standardized methodologies to fully elucidate the relationship between CMV and CV outcomes, potentially informing novel preventive and therapeutic strategies that could benefit the CV health of OTR.
尽管巨细胞病毒 (CMV) 管理取得了进展，但它对器官移植受者 (OTR) 移植物功能、死亡率和心血管 (CV) 健康的影响仍然是一个重大问题。我们研究了 CMV 感染与除心脏以外的器官移植受者 CV 事件 (CVE) 之间的关联。
我们在 PubMed 和 EMBASE 中进行了全面的文献检索，包括报告 CMV 感染或疾病与移植后 CVE 的研究。排除了心脏移植受者的研究。
我们筛选了 3875 篇摘要，最终有 12 项临床研究纳入了分析，主要涉及肾和肝移植受者。CMV 感染与 CVE 风险增加显著相关，CMV 感染的未调整合并危险比 (HR) 为 1.99（95%置信区间 [CI] 1.45-2.73），CMV 疾病为 1.59（95% CI 1.21-2.10）。合并调整后的 HR 分别为 2.17（95% CI 1.47-3.20）和 1.77（95% CI 0.83-3.76）。CMV 感染的异质性较低（I=0%），表明研究之间存在一致的相关性，而 CMV 疾病的异质性为中度至高度（未调整的 I=50%，调整后的 HR 为 53%）。
我们发现 CMV 感染与腹部 OTR 的 CV 风险之间存在显著关联，这突显了积极进行 CMV 监测和早期治疗的重要性。未来的研究应致力于采用更标准化的方法来充分阐明 CMV 与 CV 结局之间的关系，这可能为 OTR 的 CV 健康提供新的预防和治疗策略。
