肝移植环境中巨细胞病毒感染与肾损伤之间的关联。

The Association Between Cytomegalovirus Infection and Kidney Damage in the Liver Transplant Setting.

作者信息

Ossami Saidy Ramin Raul, Eurich Franziska, Globke Brigitta, Schöning Wenzel, Öllinger Robert, Raschzok Nathanael, Pratschke Johann, Eurich Dennis, Dittrich Luca, Dobrindt Eva Maria

机构信息

Department of Surgery, Campus Virchow Klinikum and Campus Charité Mitte, Charité-Universitätsmedizin Berlin, Augustenburger Platz 1, 13353 Berlin, Germany.

Berlin Institute of Health at Charité-Universitätsmedizin Berlin, BIH Academy, Clinician Scientist Program, 10117 Berlin, Germany.

出版信息

Viruses. 2024 Nov 26;16(12):1830. doi: 10.3390/v16121830.

DOI:10.3390/v16121830

PMID:39772140

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11680441/

Abstract

INTRODUCTION

The development of chronic kidney disease (CKD) is a common and significant complication, contributing to morbidity after liver transplantation (LT). Cytomegalovirus (CMV) infection is common in the overall population, and relevant reinfection after LT may occur. CMV-associated kidney damage has been discussed, but the clinical significance on CKD development after LT remains unclear.

METHODS

A total of 745 patients who underwent LT between 2006 and 2017 were included in this retrospective analysis. Clinical data, as well as laboratory parameters, were analyzed. Univariate and multivariate analysis were performed.

RESULTS

The univariate analysis revealed significantly impaired estimated glomerular filtration rates (eGFRs) in patients with histories of CMV infection (81.4 (8-137) mL/min vs. 90.0 (5-147) mL/min; = 0.004). This effect was confirmed in the multivariate analysis. Post-LT, eGFR was impaired in patients with CMV (re)infection at 6, 12, 36, and 60 months, 10 years, and 15 years after LT. Immunosuppressive levels were comparable between groups. Overall survival was negatively affected by CMV infection ( = 0.001).

DISCUSSION

A clinically significant detrimental impact of CMV infection on renal function was observed, that could individualize clinical risk evaluation prior and after LT further. However, the pathophysiological mechanisms behind this observation are not yet understood.

摘要

引言

慢性肾脏病（CKD）的发展是一种常见且严重的并发症，会导致肝移植（LT）后发病。巨细胞病毒（CMV）感染在普通人群中很常见，LT后可能会发生相关的再感染。CMV相关的肾损害已被讨论过，但LT后其对CKD发展的临床意义仍不清楚。

方法

本回顾性分析纳入了2006年至2017年间接受LT的745例患者。分析了临床数据以及实验室参数。进行了单因素和多因素分析。

结果

单因素分析显示，有CMV感染史的患者估计肾小球滤过率（eGFR）显著受损（81.4（8 - 137）mL/分钟 vs. 90.0（5 - 147）mL/分钟；P = 0.004）。多因素分析证实了这种影响。LT后，CMV（再）感染的患者在LT后6个月、12个月、36个月、60个月、10年和15年时eGFR受损。各组间免疫抑制水平相当。CMV感染对总体生存率有负面影响（P = 0.001）。