Falagas M E, Snydman D R, George M J, Werner B, Ruthazer R, Griffith J, Rohrer R H, Freeman R
Department of Medicine, New England Medical Center and Tufts University School of Medicine, 02115, USA.
Transplantation. 1996 Jun 27;61(12):1716-20. doi: 10.1097/00007890-199606270-00009.
The incidence, predictors, and outcome of cytomegalovirus pneumonia in OLT recipients have not been well defined. We conducted an analysis of prospectively collected data from 141 OLT recipients who were included as part of a randomized, placebo-controlled trial of CMV immune globulin prophylaxis. Cytomegalovirus pneumonia was diagnosed in 13 of 141 (9.2%) OLT recipients during the first year posttransplant and was associated with a higher 1-year mortality compared with those recipients without CMV pneumonia (84.6 vs. 17.2%, P=0.0001). Univariate analysis demonstrated that CMV viremia (P=0.001), invasive fungal disease (P=0.0001), donor(+)/pretransplant recipient(-) CMV serologic status (P=0.013), abdominal operation (excluding retransplantation) after liver transplantation (P=0.0027), bacteremia (P=0.0105), and advanced United Network of Organ Sharing status (P=0.023) were associated with CMV pneumonia. Cytomegalovirus viremia was diagnosed in 11 of 13 patients with CMV pneumonia at a median of 11 days (range 1-66 days) before diagnosis of CMV pneumonia. In a multivariate analysis using a time-dependent, Cox proportional hazards model, CMV viremia (RR=8.6, 95% CI 1.8-39.7, P=0.0012), invasive fungal disease (RR=6.5, 95% CI 2.1-20.3, P=0.0001), and abdominal reoperation (RR=4.4, 95% CI 1.4-13.1, P=0.0043) were found to be independent predictors of CMV pneumonia. The attributable mortality associated with CMV pneumonia within the first year after liver transplantation for the patients with CMV pneumonia was 67.4%. Intensified measures for prevention of CMV should be considered for patients at high risk of developing CMV pneumonia.
肝移植受者巨细胞病毒肺炎的发病率、预测因素及预后尚未明确界定。我们对141例肝移植受者的前瞻性收集数据进行了分析，这些受者是一项关于巨细胞病毒免疫球蛋白预防的随机、安慰剂对照试验的一部分。141例肝移植受者中有13例（9.2%）在移植后第一年被诊断为巨细胞病毒肺炎，与未发生巨细胞病毒肺炎的受者相比，其1年死亡率更高（84.6%对17.2%，P = 0.0001）。单因素分析表明，巨细胞病毒血症（P = 0.001）、侵袭性真菌病（P = 0.0001）、供体（+）/移植前受者（-）巨细胞病毒血清学状态（P = 0.013）、肝移植后腹部手术（不包括再次移植）（P = 0.0027）、菌血症（P = 0.0105）和器官共享联合网络高级状态（P = 0.023）与巨细胞病毒肺炎相关。1/13例巨细胞病毒肺炎患者在诊断巨细胞病毒肺炎前中位11天（范围1 - 66天）被诊断为巨细胞病毒血症。在使用时间依赖性Cox比例风险模型的多因素分析中，发现巨细胞病毒血症（RR = 8.6，95%CI 1.8 - 39.7，P = 0.0012）、侵袭性真菌病（RR = 6.5，95%CI 2.1 - 20.3，P = 0.0001）和腹部再次手术（RR = 4.4，95%CI 1.4 - 13.1，P = 0.0043）是巨细胞病毒肺炎的独立预测因素。肝移植后第一年，巨细胞病毒肺炎患者中与巨细胞病毒肺炎相关的归因死亡率为67.4%。对于有发生巨细胞病毒肺炎高风险的患者，应考虑采取强化的巨细胞病毒预防措施。
