Department of Medicine, Division of Infectious Diseases, University of Nebraska Medical Center, Omaha, NE, USA; Department of Medicine, Division of Infectious Diseases, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.
Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, CO, USA; Department of Pharmacy, Scripps Health, La Jolla, CA, USA.
Transplant Proc. 2024 Sep;56(7):1696-1701. doi: 10.1016/j.transproceed.2024.08.007. Epub 2024 Aug 14.
Cytomegalovirus retinitis (CMVR) is a well-described complication of CMV disease in immunocompromised hosts. While robust data exists for CMVR in patients with acquired immunodeficiency syndrome (AIDS), the incidence and risk factors for CMVR in solid organ transplant recipients (SOTR) with CMV viremia are less defined.
We performed a retrospective cohort study of SOTR who had CMV viremia and underwent routine ophthalmologic examination between 1/1/2018 and 3/16/2022. Univariate statistics were performed to evaluate risk factors for development of CMVR.
Overall, 38 patients were included, primarily kidney (78.9%), heart (7.9%), and liver (7.9%) transplant recipients. Five patients (13.2%) developed CMVR during the study period. CMVR was diagnosed an average 281 days after index transplantation, 84 days from the most recent rejection episode, and 69 days from onset of viremia. Only 1 patient (20%) had symptoms at the time of CMVR diagnosis. CMVR was associated with preceding allograft rejection as well as transplanted organ type.
While CMV tissue disease more commonly manifests in other organs, CMVR occurred relatively frequently in this group of high-risk SOTR with CMV viremia. As most of the patients in our study did not have ocular symptoms at the time of diagnosis, routine ophthalmologic screening should be considered in SOTR with CMV viremia.
巨细胞病毒视网膜炎（CMVR）是免疫功能低下宿主巨细胞病毒病的一种常见并发症。虽然在获得性免疫缺陷综合征（AIDS）患者中存在大量关于 CMVR 的数据，但在伴有巨细胞病毒血症的实体器官移植受者（SOTR）中，CMVR 的发生率和危险因素尚未明确。
我们对 2018 年 1 月 1 日至 2022 年 3 月 16 日期间接受常规眼科检查且伴有巨细胞病毒血症的 SOTR 进行了回顾性队列研究。采用单变量统计分析评估发生 CMVR 的危险因素。
总体而言，共有 38 例患者入组，主要为肾（78.9%）、心脏（7.9%）和肝脏（7.9%）移植受者。在研究期间，有 5 例患者（13.2%）发生了 CMVR。CMVR 在指数移植后平均 281 天、最近一次排斥反应后 84 天、病毒血症后 69 天被诊断。仅 1 例患者（20%）在 CMVR 诊断时存在症状。CMVR 与先前的同种异体移植排斥反应以及移植器官类型有关。
虽然 CMV 组织疾病更常见于其他器官，但在伴有巨细胞病毒血症的这组高危 SOTR 中，CMVR 发生相对频繁。由于我们研究中的大多数患者在诊断时没有眼部症状，因此应考虑对伴有巨细胞病毒血症的 SOTR 进行常规眼科筛查。
