采用监测和预防策略，CMV 错配对心脏移植结果的影响

IF 1.9 4区医学 Q2 SURGERY

Clinical Transplantation Pub Date : 2024-09-05 DOI:10.1111/ctr.15419

Guy A. MacGowan, Julie Samuel, Adam McDiarmid, Oscar Gonzalez-Fernandez, Gareth Parry

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引用次数: 0

摘要

目的：该研究旨在确定接受监测和预防性治疗方案的巨细胞病毒（CMV）不匹配患者（D+/R-）与非不匹配患者进行心脏移植后的治疗效果：对 2010 年 1 月至 2020 年 12 月的患者记录进行了回顾，并随访至 2023 年 10 月。该方案包括从移植后 4 周开始每周用 CMV PCR 进行监测，直到患者血清转换为止；如果患者没有血清转换，则在移植后 3 个月内进行监测。对血清转换者给予缬更昔洛韦治疗 2 周：结果：共纳入 221 名患者，其中 23% 为不匹配患者。CMV组之间的总生存率没有差异（P = NS）。死亡原因和发病率也无明显差异（P = NS）。66%的不匹配患者发生了血清转换，与未发生血清转换的患者相比，发生血清转换的患者的供体年龄明显偏大（41 ± 11 岁 vs. 29 ± 12 岁，p 结论：血清转换患者的死亡率和发病率没有明显增加：采用 CMV 监测和先期治疗方案不会明显增加死亡率或发病率。供体年龄对错配血清学转换的影响需要进一步验证。

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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Effect of CMV Mismatch on Heart Transplant Outcomes Using a Surveillance and Preemptive Strategy

Purpose

The aim of the study was to determine outcomes after heart transplantation for cytomegalovirus (CMV) mismatched patients (D⁺/R⁻) who underwent a surveillance and preemptive therapy protocol, compared to nonmismatch patients.

Methods

A review of patient records from January 2010 to December 2020 with follow-up to October 2023 was done. The protocol consisted weekly surveillance with CMV PCR starting 4 weeks after transplant continuing up until the patient seroconverts or up to 3 months posttransplant if the patient does not seroconvert. Valganciclovir was given for 2 weeks to those who seroconverted.

Results

Two hundred and twenty-one patients were included, and 23% were mismatched patients. Overall survival was not different between CMV groups (p = NS). Causes of death and morbidities were also not significantly different (p = NS). Sixty-six percent of mismatch patients seroconverted, and there was also a significantly older donor age in the seroconverted patients compared to nonseroconverted patients (41 ± 11 vs. 29 ± 12 years, p < 0.005), indicating a higher risk donor profile. A multivariate Cox regression including donor age showed that there was no increase in mortality in the seroconverted mismatches compared to nonmismatch patients (p = NS).

Conclusions

There is no significant increased mortality or morbidity using a CMV surveillance and preemptive therapy protocol. The effect of donor age on seroconversion of mismatches requires further validation.

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来源期刊

Clinical Transplantation 医学-外科

CiteScore

3.70

自引率

4.80%

发文量

286

审稿时长

2 months

期刊介绍： Clinical Transplantation: The Journal of Clinical and Translational Research aims to serve as a channel of rapid communication for all those involved in the care of patients who require, or have had, organ or tissue transplants, including: kidney, intestine, liver, pancreas, islets, heart, heart valves, lung, bone marrow, cornea, skin, bone, and cartilage, viable or stored. Published monthly, Clinical Transplantation’s scope is focused on the complete spectrum of present transplant therapies, as well as also those that are experimental or may become possible in future. Topics include: Immunology and immunosuppression; Patient preparation; Social, ethical, and psychological issues; Complications, short- and long-term results; Artificial organs; Donation and preservation of organ and tissue; Translational studies; Advances in tissue typing; Updates on transplant pathology;. Clinical and translational studies are particularly welcome, as well as focused reviews. Full-length papers and short communications are invited. Clinical reviews are encouraged, as well as seminal papers in basic science which might lead to immediate clinical application. Prominence is regularly given to the results of cooperative surveys conducted by the organ and tissue transplant registries. Clinical Transplantation: The Journal of Clinical and Translational Research is essential reading for clinicians and researchers in the diverse field of transplantation: surgeons; clinical immunologists; cryobiologists; hematologists; gastroenterologists; hepatologists; pulmonologists; nephrologists; cardiologists; and endocrinologists. It will also be of interest to sociologists, psychologists, research workers, and to all health professionals whose combined efforts will improve the prognosis of transplant recipients.