Abstract：
This study aimed to characterize patient risk groups and respective prognostic profiles to optimize clinical decision-making and guide appropriate medical cytomegalovirus (CMV) management among patients with solid organ transplant (SOT).
Between September 2021 and February 2022, a three-round modified Delphi study was conducted to generate consensus among 14 international experts in virology and organ transplantation. Experts were asked about treatment and prognoses for patients in seven distinct clinical scenarios. Furthermore, experts were asked to risk-stratify patients by pre-/post-transplant characteristics. Consensus around opting for/against a treatment was observed if ≥75% or <25% of experts reported ≥50% likelihood to recommend or if treatments were ranked inside/outside the top two options and ≥75% of experts were within 1 standard deviation of the mean rank.
Experts agreed on several unmet needs in CMV disease management post-SOT, particularly avoidance of treatment-limiting toxicities with conventional CMV therapy and emergence of both primary refractory and drug resistant treatment failures. Experts considered CMV viral load, resistance profile, and route of administration as critical to treatment selection. For newer CMV therapeutic options, experts listed lack of long-term use data, concerns over potential resistance, high cost and limited availability as challenges restricting adoption, and successful patient management.
Experts achieved consensus around patient risk stratifications and factors influencing therapeutic options. Recommendations emerging from this Delphi study may support practicing physicians when confronted with challenging CMV scenarios in SOT patients, but additional experiences with newer anti-CMV agents are needed to re-validate expert consensus and update post-transplant CMV guidelines.
Between September 2021 and February 2022, a three-round modified Delphi study was conducted to generate consensus among 14 international experts in virology and organ transplantation. Experts were asked about treatment and prognoses for patients in seven distinct clinical scenarios. Furthermore, experts were asked to risk-stratify patients by pre-/post-transplant characteristics. Consensus around opting for/against a treatment was observed if ≥75% or <25% of experts reported ≥50% likelihood to recommend or if treatments were ranked inside/outside the top two options and ≥75% of experts were within 1 standard deviation of the mean rank.
Experts agreed on several unmet needs in CMV disease management post-SOT, particularly avoidance of treatment-limiting toxicities with conventional CMV therapy and emergence of both primary refractory and drug resistant treatment failures. Experts considered CMV viral load, resistance profile, and route of administration as critical to treatment selection. For newer CMV therapeutic options, experts listed lack of long-term use data, concerns over potential resistance, high cost and limited availability as challenges restricting adoption, and successful patient management.
Experts achieved consensus around patient risk stratifications and factors influencing therapeutic options. Recommendations emerging from this Delphi study may support practicing physicians when confronted with challenging CMV scenarios in SOT patients, but additional experiences with newer anti-CMV agents are needed to re-validate expert consensus and update post-transplant CMV guidelines.
摘要：
背景：本研究旨在表征患者的风险群体和各自的预后状况，以优化实体器官移植（SOT）患者的临床决策并指导适当的医学CMV管理。
方法：在2021年9月2日至2022年2月2日之间，进行了3轮改良的Delphi研究，以在病毒学和器官移植的14名国际专家中达成共识。在7种不同的临床情况下，专家被问及患者的治疗和预后。此外，专家被要求根据移植前/后的特征对患者进行风险分层.如果≥75％或<25％的专家报告推荐的可能性≥50％，或者如果治疗排名在前2个选项之内/之外，并且≥75％的专家在1个标准差之内，则观察到关于选择/反对治疗的共识。平均排名。
结果：专家们就SOT后CMV疾病管理中几个未满足的需求达成一致，特别是避免使用常规CMV治疗的治疗限制性毒性，以及出现主要难治性和耐药性治疗失败。专家认为CMV病毒载量，抗性概况和给药途径对治疗选择至关重要。对于较新的CMV治疗选择，专家列出缺乏长期使用数据，对潜在阻力的担忧，高成本和有限的可用性作为挑战限制采用和成功的患者管理。
结论：专家就患者风险分层和影响治疗选择的因素达成了共识。本Delphi研究提出的建议可能会在SOT患者面临具有挑战性的CMV场景时支持执业医师，但需要使用新型抗CMV药物的更多经验,以重新验证专家共识并更新移植后CMV指南.本文受版权保护。保留所有权利。
方法：在2021年9月2日至2022年2月2日之间，进行了3轮改良的Delphi研究，以在病毒学和器官移植的14名国际专家中达成共识。在7种不同的临床情况下，专家被问及患者的治疗和预后。此外，专家被要求根据移植前/后的特征对患者进行风险分层.如果≥75％或<25％的专家报告推荐的可能性≥50％，或者如果治疗排名在前2个选项之内/之外，并且≥75％的专家在1个标准差之内，则观察到关于选择/反对治疗的共识。平均排名。
结果：专家们就SOT后CMV疾病管理中几个未满足的需求达成一致，特别是避免使用常规CMV治疗的治疗限制性毒性，以及出现主要难治性和耐药性治疗失败。专家认为CMV病毒载量，抗性概况和给药途径对治疗选择至关重要。对于较新的CMV治疗选择，专家列出缺乏长期使用数据，对潜在阻力的担忧，高成本和有限的可用性作为挑战限制采用和成功的患者管理。
结论：专家就患者风险分层和影响治疗选择的因素达成了共识。本Delphi研究提出的建议可能会在SOT患者面临具有挑战性的CMV场景时支持执业医师，但需要使用新型抗CMV药物的更多经验,以重新验证专家共识并更新移植后CMV指南.本文受版权保护。保留所有权利。
