心脏移植中的高危巨细胞病毒：如何改善？

IF 0.8 4区医学 Q4 IMMUNOLOGY

Transplantation proceedings Pub Date : 2025-01-01 DOI:10.1016/j.transproceed.2024.11.024

Andrea Severo , Javier González Martín , Cristina Mateo Gómez , Josefina Arias Mahiques , Alexia Denisse Aguzezko , María Eugenia Tanaro , Ruth Echeverría , Javier de Juan Bagudá , Christian Muñoz Guijosa , Francisco López Medrano , Juan Delgado , María Dolores García-Cosío Carmena

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引用次数: 0

摘要

背景：巨细胞病毒（CMV）感染与心脏移植（HT）后较差的预后相关。巨细胞病毒不匹配（供体阳性，受体阴性血清学，D+/R-）增加感染的风险。指南建议对这些患者进行3至6个月的抗病毒预防治疗。我们中心原发性巨细胞病毒感染的增加促使我们对这一人群进行分析以寻求改善。方法：从10年来的185名成人HT受体中选择CMV D+/R-的受体。患者随访至2023年10月。我们根据目前的建议评估了巨细胞病毒的传播模式。结果：我们评估了35例CMV不匹配的HT受体（中位年龄48.8±13.8岁，71%为男性）。中位随访时间为5.5年[1.9-7.4]。治疗后CMV预防的中位持续时间为3.7（±2.1）个月。74%的患者发生巨细胞病毒感染（96%在结束预防后的前6个月内），26%的患者发生巨细胞病毒疾病。其中一半需要住院治疗。三分之一的人同时感染了其他微生物。有巨细胞病毒感染和没有巨细胞病毒感染的患者的预防持续时间没有显著差异。随访生存率为77%。2例因巨细胞病毒感染而死亡。结论：即使在现行指南推荐的预防期后，D+/R- HT受体的巨细胞病毒感染率仍然很高。更好地了解巨细胞病毒传播感染，再加上在预防感染和排斥反应之间寻求适当的平衡，有可能通过量身定制的方案提高这一高危人群的治疗效果。

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High-risk Cytomegalovirus in Heart Transplant: How Can We Improve?

Background

Cytomegalovirus (CMV) infection is associated with worse outcomes after heart transplant (HT). CMV mismatch (donor positive, recipient negative serology, D+/R-) increases the risk of infection. Guidelines recommend 3 to 6 months of antiviral prophylaxis in these patients. An increase in primary CMV infections at our center prompted us to analyses this population in search of improvement.

Methods

From 185 adult HT receptors in 10 years, we selected those with CMV D+/R-. Patients were followed until October 2023. We evaluated the patterns of transmission of CMV in accordance with current recommendations.

Results

We assessed 35 HT recipients with CMV mismatch (median age of 48.8 ± 13.8 years, 71% men). Median follow-up was 5.5 years [1.9-7.4]. Median duration of CMV prophylaxis was 3.7 (±2.1) months post-HT. CMV infection occurred in 74% of patients (96% within the first 6 months after ending prophylaxis) and CMV disease in 26%. Half of them required hospital admission. One third had concomitant infections by other microorganisms. There were no significant differences in the duration of prophylaxis between patients with and without CMV infection. Survival on follow-up was 77%. 2 patients died during CMV infection due to other infection.

Conclusions

CMV infection rate in D+/R- HT receptors remains high even after the prophylactic period recommended by current guidelines. A better knowledge of CMV-transmitted infection, coupled with the pursuit of a suitable equilibrium between the prevention of infection and rejection, have the potential to enhance the outcomes of this high-risk population through tailored protocols.

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来源期刊

Transplantation proceedings 医学-免疫学

CiteScore

1.70

自引率

0.00%

发文量

502

审稿时长

60 days

期刊介绍： Transplantation Proceedings publishes several different categories of manuscripts, all of which undergo extensive peer review by recognized authorities in the field prior to their acceptance for publication. The first type of manuscripts consists of sets of papers providing an in-depth expression of the current state of the art in various rapidly developing components of world transplantation biology and medicine. These manuscripts emanate from congresses of the affiliated transplantation societies, from Symposia sponsored by the Societies, as well as special Conferences and Workshops covering related topics. Transplantation Proceedings also publishes several special sections including publication of Clinical Transplantation Proceedings, being rapid original contributions of preclinical and clinical experiences. These manuscripts undergo review by members of the Editorial Board. Original basic or clinical science articles, clinical trials and case studies can be submitted to the journal?s open access companion title Transplantation Reports.