Department of Pharmacy, University of Wisconsin Hospital and Clinics, Madison, Wisconsin, USA.
Depart of Surgery, University of Wisconsin-Madison School of Medicine and Public Health, University of Wisconsin Hospital and Clinics, Madison, Wisconsin, USA.
Clin Transplant. 2024 Sep;38(9):e15453. doi: 10.1111/ctr.15453.
Evaluate cytomegalovirus (CMV) post-prophylaxis surveillance in high-risk (D+/R-) kidney and liver transplant recipients.
Adult D+/R- patients were included if transplanted between 6/1/15 and 11/30/22 and divided into a pre-CMV-stewardship-era (6/1/15-5/31/18), CMV-stewardship-era (6/1/18-6/30/20), and a surveillance-era (7/1/2020-11/30/2022) then followed through 12 months. The primary objective was to evaluate CMV-related outcomes. The secondary objective was to assess graft and patient survival by era.
There were 328 patients in the study period; 133 in the pre-stewardship-era, 103 in the stewardship-era, and 92 in the surveillance-era. Replication rates in the surveillance-era were significantly higher, as anticipated due to increased sampling (pre 38.4%, stewardship 33.0%, surveillance 52.2%, p = 0.02). Time from transplant to first replication was similar (pre 214.0 ± 79.0 days, stewardship 231.1 ± 65.5, surveillance 234.9 ± 61.4, p = 0.29). CMV viral load (VL) at first detection, maximum-VL, and incidence of VL > 100 000 IU/mL were numerically lower in the surveillance era, although not statistically significant. CMV end-organ disease (p < 0.0001) and ganciclovir-resistance (p = 0.002) were significantly lower in the surveillance era than in both previous eras. Rejection was not different between eras (p = 0.4). Graft (p = 0.0007) and patient survival (p = 0.008) were significantly improved in the surveillance era.
Post-prophylaxis surveillance significantly reduced CMV end-organ disease and resistance. Despite observing increased replication rates in the surveillance era, rejection was not significantly different and there was no graft loss or patient mortality at 12 months.
评估高危（D+/R-）肾和肝移植受者的巨细胞病毒（CMV）预防后监测。
如果患者在 2015 年 6 月 1 日至 2022 年 11 月 30 日之间接受移植，则将其纳入研究，将其分为 CMV 管理前时代（2015 年 6 月 1 日至 2018 年 5 月 31 日）、CMV 管理时代（2018 年 6 月 1 日至 2020 年 6 月 30 日）和监测时代（2020 年 7 月 1 日至 2022 年 11 月 30 日），然后随访 12 个月。主要目标是评估 CMV 相关结局。次要目标是按时代评估移植物和患者存活率。
研究期间共有 328 例患者；管理前时代 133 例，管理时代 103 例，监测时代 92 例。由于增加了采样，预计在监测时代的复制率会更高（管理前为 38.4%，管理时代为 33.0%，监测时代为 52.2%，p=0.02）。从移植到第一次复制的时间相似（管理前为 214.0±79.0 天，管理时代为 231.1±65.5 天，监测时代为 234.9±61.4 天，p=0.29）。CMV 病毒载量（VL）在第一次检测时、最大 VL 时以及 VL > 100000 IU/mL 的发生率在监测时代略有下降，但无统计学意义。CMV 终末器官疾病（p<0.0001）和更昔洛韦耐药（p=0.002）在监测时代明显低于前两个时代。各时代之间排斥反应无差异（p=0.4）。在监测时代，移植物（p=0.0007）和患者存活率（p=0.008）显著提高。
预防后监测显著降低了 CMV 终末器官疾病和耐药性。尽管在监测时代观察到复制率增加，但排斥反应无显著差异，12 个月时无移植物丢失或患者死亡。
