Risk of Cytomegalovirus Viremia Following Transplantation of Hepatitis C-Viremic Donor Kidneys Into Uninfected Recipients: A Multi-Center Retrospective Cohort Study.

IF 2.6 4区医学 Q3 IMMUNOLOGY

Transplant Infectious Disease Pub Date : 2025-03-06 DOI:10.1111/tid.70011

Vishnu S Potluri, David Goldberg, Siqi Zhang, Douglas E Schaubel, Miklos Z Molnar, Rachel Forbes, Megan E Sise, James L Rogers, Vasanthi Balaraman, Anshul Bhalla, David Shaffer, Beatrice P Concepcion, Raymond T Chung, Ian A Strohbehn, Shristi Mapchan, Vikas Vujjini, Akhila Sangadi, Eric Martin, Roy D Bloom, Alyssa Ammazzalorso, Emily A Blumberg, Peter P Reese

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引用次数: 0

Abstract

Background: Several studies have suggested an increased risk of cytomegalovirus (CMV) viremia among Hepatitis C virus (HCV)-uninfected recipients of kidney transplants from HCV-RNA+ deceased donors (HCV D+/R-), but these studies featured small sample sizes and limited ability to address confounding variables.

Methods: We assembled a retrospective cohort of adult kidney transplant recipients at five US centers between 4/1/2015 and 12/31/2020 to determine the association between HCV D+/R- transplants and the outcomes of CMV viremia (> 1000 IU/mL), death-censored graft failure, and mortality in the first posttransplant year compared to HCV D-/R- transplants. We generated highly similar matched cohorts of HCV D+/R- and HCV D-/R- recipients based on attributes that affect the risk of CMV viremia. We matched exactly on center, CMV donor/recipient serostatus, and antibody induction therapy.

Results: The cohort comprised 275 HCV D+/R- recipients with a mean age of 52.5 years (SD = 10.7); 19% were CMV D+/R-, and 74% received anti-thymocyte globulin induction. With variable ratio matching, 267 HCV D+/R- recipients were matched to 996 HCV D-/R- recipients. CMV viremia occurred in 15% of HCV D+/R- and 11% of HCV D-R- recipients. In Cox regression, transplantation with an HCV-RNA+ donor kidney was not associated with a significantly higher risk of CMV viremia (HR 1.3, 95% CI 0.89-1.92) or death-censored graft loss (HR 0.61, 95% CI 0.31-1.2).

Conclusion: The risk of CMV viremia was not significantly increased among HCV D+/R- kidney recipients. Future studies should examine associations between donor-derived HCV infection and clinical outcomes of CMV syndrome and disease.

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将丙型肝炎病毒感染的供肾移植给未感染的受体后出现巨细胞病毒感染的风险：一项多中心回顾性队列研究。

背景：几项研究表明，来自HCV- rna +已故供者（HCV D+/R-）的未感染丙型肝炎病毒（HCV）的肾移植受者发生巨细胞病毒（CMV）病毒血症的风险增加，但这些研究样本量小，处理混杂变量的能力有限。方法：我们在2015年4月1日至2020年12月31日期间在美国五个中心对成人肾移植受者进行回顾性队列研究，以确定与HCV D-/R-移植相比，HCV D+/R-移植与CMV病毒血症（bb0 1000 IU/mL）、死亡审查移植失败和移植后第一年死亡率之间的关系。基于影响CMV病毒血症风险的属性，我们生成了高度相似的HCV D+/R-和HCV D-/R-受体匹配队列。我们在中心、巨细胞病毒供体/受体血清状态和抗体诱导治疗上完全匹配。结果：该队列包括275名HCV D+/R-受体，平均年龄为52.5岁（SD = 10.7）；19%为CMV D+/R-， 74%为抗胸腺细胞球蛋白诱导。通过可变比例匹配，267名HCV D+/R-受体与996名HCV D-/R-受体匹配。15%的HCV D+/R-受体和11%的HCV D-R-受体发生巨细胞病毒血症。在Cox回归中，HCV-RNA+供体肾脏移植与CMV病毒血症（HR 1.3, 95% CI 0.89-1.92）或死亡审查移植损失（HR 0.61, 95% CI 0.31-1.2）的风险显著升高无关。结论：在HCV D+/R-肾移植患者中，CMV病毒血症的发生风险没有显著增加。未来的研究应检查供体来源的HCV感染与CMV综合征和疾病的临床结果之间的关系。

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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来源期刊

Transplant Infectious Disease 医学-传染病学

CiteScore

5.30

自引率

7.70%

发文量

210

审稿时长

4-8 weeks

期刊介绍： Transplant Infectious Disease has been established as a forum for presenting the most current information on the prevention and treatment of infection complicating organ and bone marrow transplantation. The point of view of the journal is that infection and allograft rejection (or graft-versus-host disease) are closely intertwined, and that advances in one area will have immediate consequences on the other. The interaction of the transplant recipient with potential microbial invaders, the impact of immunosuppressive strategies on this interaction, and the effects of cytokines, growth factors, and chemokines liberated during the course of infections, rejection, or graft-versus-host disease are central to the interests and mission of this journal. Transplant Infectious Disease is aimed at disseminating the latest information relevant to the infectious disease complications of transplantation to clinicians and scientists involved in bone marrow, kidney, liver, heart, lung, intestinal, and pancreatic transplantation. The infectious disease consequences and concerns regarding innovative transplant strategies, from novel immunosuppressive agents to xenotransplantation, are very much a concern of this journal. In addition, this journal feels a particular responsibility to inform primary care practitioners in the community, who increasingly are sharing the responsibility for the care of these patients, of the special considerations regarding the prevention and treatment of infection in transplant recipients. As exemplified by the international editorial board, articles are sought throughout the world that address both general issues and those of a more restricted geographic import.