6个月预防方案后肾移植受者晚期巨细胞病毒感染

IF 0.3 Q4 TRANSPLANTATION International Journal of Organ Transplantation Medicine Pub Date : 2019-01-01 Epub Date: 2010-02-01
L Cunha, I Laranjinha, R Birne, C Jorge, T J Carvalho, A Lança, S Coelho, M Bruges, D Machado
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引用次数: 0

摘要

背景:尽管肾移植后巨细胞病毒(CMV)感染的发生率降低,但对肾移植受者晚期巨细胞病毒感染的了解较少。目的:评估CMV高监测预防方案患者队列中CMV感染的发生率,并确定晚期CMV感染的相关因素。方法:对2012年1月至2015年8月期间181例同种异体肾移植受者进行连续队列分析。CMV预防方案包括对高危组(D+/R-或接受淋巴细胞消耗剂诱导或排斥治疗的患者)进行6个月的普遍预防和先发制人治疗,对标准危险组(D±/R+)进行先发制人治疗。停止缬更昔洛韦后,在接下来的两次预约中进行巨细胞病毒筛查。结果:181例患者中有73例发现巨细胞病毒感染;高危组和标准危险组的发生率相似(p=0.443)。而在后者中,感染主要发生在前6个月。181例患者中有25例(标准危险组5例,高危组20例)发生晚期巨细胞病毒感染,移植后中位(IQR)为253(230.3-312.3)天,方案期后为55(41-89.5)天。缬更昔洛韦停药后的巨细胞病毒筛查显示56%的晚期巨细胞病毒感染。高危组D+/R-与CMV晚期感染相关(HR 2.7, p=0.039),标准危组D+/R-与CMV晚期感染相关;较低的年龄与晚期巨细胞病毒感染相关(HR 0.89, p=0.02)。结论:巨细胞病毒感染发生率与文献报道相似。在高危患者中,预防期间的抗原血症监测似乎并没有减少晚期巨细胞病毒感染。缬更昔洛韦后抗原血症筛查对晚期巨细胞病毒感染的诊断结果有限。D+/R-与高危组晚期巨细胞病毒感染相关。低年龄对标准危险组晚期巨细胞病毒感染有影响。
本文章由计算机程序翻译,如有差异,请以英文原文为准。

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Late Cytomegalovirus Infection in Kidney Transplant Recipients after a Six-Month Prevention Protocol.

Background: Despite a reduction in the incidence of cytomegalovirus (CMV) infections after kidney transplantation, less is known about late CMV infection in kidney transplant recipients.

Objective: To assess incidence of CMV infection in a cohort of patients under a high surveillance CMV prevention protocol and identify factors associated with late CMV infection.

Methods: Analysis of a consecutive cohort of 181 kidney allograft recipients between January 2012 and Aug 2015. CMV prevention-protocol consisted of 6-month universal prophylaxis and pre-emptive therapy for high-risk group (D+/R- or patients submitted to lymphocyte-depleting agent for induction or rejection treatment) and pre-emptive therapy for standard-risk group (D±/R+). Stopping valganciclovir was followed by CMV screening in the next two appointments.

Results: CMV infection was identified in 73 of 181 patients; the rate in high-risk group and standard-risk group was similar (p=0.443). However, in the latter group, the infection occurred mostly in the first 6 months. Late CMV infection occurred in 25 of 181 patients (5 of standard-risk group and 20 of high-risk group), after a median (IQR) of 253 (230.3-312.3) days after transplantation and 55 (41-89.5) days after the protocol period. Screening for CMV after valganciclovir discontinuation revealed 56% of late CMV infections. In high-risk group, D+/R- was associated with late CMV infection (HR 2.7, p=0.039) and in standard-risk group; lower age was associated with late CMV infection (HR 0.89, p=0.02).

Conclusion: The incidence of CMV infection was similar to that reported in the literature. In high-risk patients, antigenemia surveillance during prophylaxis did not appear to reduce late CMV infections. Antigenemia screening after valganciclovir had limited results in the diagnosis of late CMV infection. D+/R- was associated to late CMV infection in high-risk group. Lower age appeared to influence late CMV infection in standard-risk group.

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来源期刊
CiteScore
1.60
自引率
0.00%
发文量
0
审稿时长
12 weeks
期刊介绍: The International Journal of Organ Transplantation Medicine (IJOTM) is a quarterly peer-reviewed English-language journal that publishes high-quality basic sciences and clinical research on transplantation. The scope of the journal includes organ and tissue donation, procurement and preservation; surgical techniques, innovations, and novelties in all aspects of transplantation; genomics and immunobiology; immunosuppressive drugs and pharmacology relevant to transplantation; graft survival and prevention of graft dysfunction and failure; clinical trials and population analyses in the field of transplantation; transplant complications; cell and tissue transplantation; infection; post-transplant malignancies; sociological and ethical issues and xenotransplantation.
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