PDF(Pubmed)
Abstract：
Cytomegalovirus (CMV) infection is the most common opportunistic infection that occurs following orthotopic liver transplantation (OLT). In addition to the direct infection-related symptoms, it also triggers an immunological response that may contribute to adverse clinical outcomes. CMV disease has been described as a predictor of invasive fungal infections (IFIs) but its role under an antiviral prophylaxis regimen is unclear.
METHODS: We retrospectively analyzed the medical records of 214 adult liver transplant recipients (LTRs). Universal antiviral prophylaxis was utilized in recipients with CMV mismatch; intermediate- and low-risk patients received pre-emptive treatment.
RESULTS: Six percent of patients developed CMV disease independent of their serostatus. The occurrence of CMV disease was associated with elevated virus load and increased incidence of leucopenia and IFIs. Furthermore, CMV disease was associated with higher one-year mortality and increased relapse rates within the first year of OLT.
CONCLUSIONS: CMV disease causes significant morbidity and mortality in LTRs, directly affecting transplant outcomes. Due to the increased risk of IFIs, antifungal prophylaxis for CMV disease may be appropriate. Postoperative CMV monitoring should be considered after massive transfusion, even in low-risk serostatus constellations. In case of biliary complications, biliary CMV monitoring may be appropriate in the case of CMV-DNA blood-negative patients.
METHODS: We retrospectively analyzed the medical records of 214 adult liver transplant recipients (LTRs). Universal antiviral prophylaxis was utilized in recipients with CMV mismatch; intermediate- and low-risk patients received pre-emptive treatment.
RESULTS: Six percent of patients developed CMV disease independent of their serostatus. The occurrence of CMV disease was associated with elevated virus load and increased incidence of leucopenia and IFIs. Furthermore, CMV disease was associated with higher one-year mortality and increased relapse rates within the first year of OLT.
CONCLUSIONS: CMV disease causes significant morbidity and mortality in LTRs, directly affecting transplant outcomes. Due to the increased risk of IFIs, antifungal prophylaxis for CMV disease may be appropriate. Postoperative CMV monitoring should be considered after massive transfusion, even in low-risk serostatus constellations. In case of biliary complications, biliary CMV monitoring may be appropriate in the case of CMV-DNA blood-negative patients.
摘要：
巨细胞病毒（CMV）感染是原位肝移植（OLT）后最常见的机会性感染。除了与感染相关的直接症状,它还会引发可能导致不良临床结局的免疫反应.CMV疾病已被描述为侵袭性真菌感染（IFIs）的预测因子，但其在抗病毒预防方案下的作用尚不清楚。
方法：我们回顾性分析了214例成人肝移植受者（LTR）的病历。在CMV不匹配的接受者中使用了通用抗病毒预防;中危和低危患者接受了先发制人的治疗。
结果：6%的患者独立于血清状态发展为CMV疾病。CMV病的发生与病毒载量的升高以及白细胞减少症和IFIs的发生率增加有关。此外，CMV疾病与OLT第一年内的较高一年死亡率和复发率增加相关。
结论：CMV疾病在LTR中导致显著的发病率和死亡率，直接影响移植结果。由于国际金融机构的风险增加，CMV疾病的抗真菌预防可能是合适的。大量输血后应考虑术后CMV监测，即使在低风险血清状态星座。在胆道并发症的情况下，对于CMV-DNA血阴性患者,胆道CMV监测可能是合适的.
方法：我们回顾性分析了214例成人肝移植受者（LTR）的病历。在CMV不匹配的接受者中使用了通用抗病毒预防;中危和低危患者接受了先发制人的治疗。
结果：6%的患者独立于血清状态发展为CMV疾病。CMV病的发生与病毒载量的升高以及白细胞减少症和IFIs的发生率增加有关。此外，CMV疾病与OLT第一年内的较高一年死亡率和复发率增加相关。
结论：CMV疾病在LTR中导致显著的发病率和死亡率，直接影响移植结果。由于国际金融机构的风险增加，CMV疾病的抗真菌预防可能是合适的。大量输血后应考虑术后CMV监测，即使在低风险血清状态星座。在胆道并发症的情况下，对于CMV-DNA血阴性患者,胆道CMV监测可能是合适的.
