Falagas M E, Snydman D R, Griffith J, Ruthazer R, Werner B G
New England Medical Center, Boston, Massachusetts, USA.
Ann Intern Med. 1997 Feb 15;126(4):275-9. doi: 10.7326/0003-4819-126-4-199702150-00003.
To reduce the mortality rate associated with liver transplantation, it is important to identify the risk factors for increased mortality among liver transplant recipients. It has been suggested that cytomegalovirus (CMV) infection is one such risk factor, but no studies have examined mortality rates associated with the CMV serologic status of the donor and recipient by using multivariate techniques.
To study the effect of CMV on 1-year mortality rates in orthotopic liver transplant recipients.
Intention-to-treat analysis of a cohort.
146 liver transplant recipients who were enrolled in a multicenter, randomized, placebo-controlled intervention trial.
Four university-affiliated transplantation centers.
1-year mortality rates for the four strata of donor and recipient CMV serologic status before transplantation were as follows: seronegative donor and recipient, 11%; seronegative donor and seropositive recipient, 22%; seropositive donor and recipient, 30%; and seropositive donor and seronegative recipient, 44% (P = 0.0091). Multivariate analysis using a time-dependent Cox proportional hazards model showed that retransplantation (relative risk, 4.6 [95% CI, 1.9 to 10.7]; P < 0.001); total number of units of blood products administered during transplantation (relative risk, 1.006 per unit [CI, 1.003 to 1.010]; P < 0.001); and presence of CMV disease (relative risk, 3.9 [CI, 1.8 to 8.5]; P < 0.001), invasive fungal disease (relative risk, 3.3 [CI, 1.5 to 7.1]; P = 0.0020), and bacteremia (relative risk, 2.5 [CI, 1.2 to 5.2]; P = 0.0136) were independently associated with higher mortality rates. If post-transplantation variables that were highly correlated with donor and recipient CMV serologic status were restricted from the model, donor and recipient CMV serologic status was the only pretransplantation variable independently associated with higher mortality rates (P = 0.002).
Donor and recipient CMV serologic status is a significant pretransplantation determinant for death in liver transplant recipients.
为降低肝移植相关的死亡率，识别肝移植受者中死亡率增加的风险因素很重要。有人提出巨细胞病毒（CMV）感染是其中一个风险因素，但尚无研究使用多变量技术研究与供体和受者CMV血清学状态相关的死亡率。
研究CMV对原位肝移植受者1年死亡率的影响。
对一个队列进行意向性分析。
146名肝移植受者，他们参加了一项多中心、随机、安慰剂对照干预试验。
四个大学附属医院的移植中心。
移植前供体和受者CMV血清学状态的四个分层的1年死亡率如下：血清阴性供体和血清阴性受者，11%；血清阴性供体和血清阳性受者，22%；血清阳性供体和血清阳性受者，30%；血清阳性供体和血清阴性受者，44%（P = 0.0091）。使用时间依赖性Cox比例风险模型进行的多变量分析显示，再次移植（相对风险，4.6 [95% CI，1.9至10.7]；P < 0.001）；移植期间输注的血液制品单位总数（相对风险，每单位1.006 [CI，1.003至1.010]；P < 0.001）；以及CMV疾病的存在（相对风险，3.9 [CI，1.8至8.5]；P < 0.001）、侵袭性真菌病（相对风险，3.3 [CI，1.5至7.1]；P = 0.0020）和菌血症（相对风险，2.5 [CI，1.2至5.2]；P = 0.0136）与较高的死亡率独立相关。如果从模型中排除与供体和受者CMV血清学状态高度相关的移植后变量，则供体和受者CMV血清学状态是唯一与较高死亡率独立相关的移植前变量（P = 0.002）。
供体和受者CMV血清学状态是肝移植受者移植前死亡的一个重要决定因素。
