PDF(Pubmed)
Abstract：
The cytomegalovirus (CMV) mismatch rate in deceased donor kidney transplant (DDKT) recipients in the US remains above 40%. Since CMV mismatching is common in DDKT recipients, the cumulative effects may be significant in the context of overall patient and graft survival. Our primary objective was to describe the short- and long-term risks associated with high-risk CMV donor positive/recipient negative (D+/R-) mismatching among DDKT recipients with the explicit goal of deriving a mathematical mismatching penalty.
We conducted a retrospective, secondary analysis of the Scientific Registry of Transplant Recipients (SRTR) database using donor-matched DDKT recipient pairs (N=105,608) transplanted between 2011-2022. All-cause mortality and graft failure hazard ratios were calculated from one year to ten years post-DDKT. All-cause graft failure included death events. Survival curves were calculated using the Kaplan-Meier estimation at 10 years post-DDKT and extrapolated to 20 years to provide the average graft days lost (aGDL) and average patient days lost (aPDL) due to CMV D+/R- serostatus mismatching. We also performed an age-based stratification analysis to compare the relative risk of CMV D+ mismatching by age.
Among 31,518 CMV D+/R- recipients, at 1 year post-DDKT, the relative risk of death increased by 29% (p<0.001), and graft failure increased by 17% (p<0.001) as compared to matched CMV D+/R+ group (N=31,518). Age stratification demonstrated a significant increase in the risk associated with CMV mismatching in patients 40 years of age and greater. The aGDL per patient due to mismatching was 125 days and the aPDL per patient was 100 days.
The risks of CMV D+/R- mismatching are seen both at 1 year post-DDKT period and accumulated throughout the lifespan of the patient, with the average CMV D+/R- recipient losing more than three months of post-DDKT survival time. CMV D+/R- mismatching poses a more significant risk and a greater health burden than previously reported, thus obviating the need for better preventive strategies including CMV serodirected organ allocation to prolong lifespans and graft survival in high-risk patients.
We conducted a retrospective, secondary analysis of the Scientific Registry of Transplant Recipients (SRTR) database using donor-matched DDKT recipient pairs (N=105,608) transplanted between 2011-2022. All-cause mortality and graft failure hazard ratios were calculated from one year to ten years post-DDKT. All-cause graft failure included death events. Survival curves were calculated using the Kaplan-Meier estimation at 10 years post-DDKT and extrapolated to 20 years to provide the average graft days lost (aGDL) and average patient days lost (aPDL) due to CMV D+/R- serostatus mismatching. We also performed an age-based stratification analysis to compare the relative risk of CMV D+ mismatching by age.
Among 31,518 CMV D+/R- recipients, at 1 year post-DDKT, the relative risk of death increased by 29% (p<0.001), and graft failure increased by 17% (p<0.001) as compared to matched CMV D+/R+ group (N=31,518). Age stratification demonstrated a significant increase in the risk associated with CMV mismatching in patients 40 years of age and greater. The aGDL per patient due to mismatching was 125 days and the aPDL per patient was 100 days.
The risks of CMV D+/R- mismatching are seen both at 1 year post-DDKT period and accumulated throughout the lifespan of the patient, with the average CMV D+/R- recipient losing more than three months of post-DDKT survival time. CMV D+/R- mismatching poses a more significant risk and a greater health burden than previously reported, thus obviating the need for better preventive strategies including CMV serodirected organ allocation to prolong lifespans and graft survival in high-risk patients.
摘要：
■在美国，已故供体肾移植（DDKT）接受者的巨细胞病毒（CMV）错配率保持在40％以上。由于CMV不匹配在DDKT接收者中很常见，在总体患者和移植物存活的情况下,累积效应可能是显著的.我们的主要目标是描述DDKT接受者之间与高风险CMV供体阳性/受体阴性（D/R-）不匹配相关的短期和长期风险，其明确目标是得出数学上的不匹配惩罚。
■我们进行了回顾，使用2011-2022年之间移植的供体匹配的DDKT受体对（N=105,608）对移植受体科学注册（SRTR）数据库进行二次分析。DDKT后1年至10年计算全因死亡率和移植物衰竭风险比。全因移植物失败包括死亡事件。使用DDKT后10年的Kaplan-Meier估计计算存活曲线，并推断至20年，以提供由于CMVD/R-血清状态不匹配而导致的平均移植天数损失（aGDL）和平均患者天数损失（aPDL）。我们还进行了基于年龄的分层分析，以比较不同年龄的CMVD+错配的相对风险。
■在31,518名CMVD+/R-收件人中，在DDKT后1年，相对死亡风险增加29%(p<0.001)，与匹配的CMVD/R组（N=31,518）相比，移植物衰竭增加了17％（p<0.001）。年龄分层显示，在40岁及以上的患者中，与CMV错配相关的风险显着增加。由于不匹配导致的每个患者的aGDL为125天,并且每个患者的aPDL为100天。
■CMVD+/R-不匹配的风险见于DDKT后1年，并在患者的整个生命周期中累积。平均CMVD+/R-接受者失去超过三个月的DDKT后生存时间。CMVD+/R-不匹配会带来比以前报道的更大的风险和更大的健康负担，从而避免了对更好的预防策略的需要,包括CMV血清定向器官分配,以延长高危患者的寿命和移植物存活.
■我们进行了回顾，使用2011-2022年之间移植的供体匹配的DDKT受体对（N=105,608）对移植受体科学注册（SRTR）数据库进行二次分析。DDKT后1年至10年计算全因死亡率和移植物衰竭风险比。全因移植物失败包括死亡事件。使用DDKT后10年的Kaplan-Meier估计计算存活曲线，并推断至20年，以提供由于CMVD/R-血清状态不匹配而导致的平均移植天数损失（aGDL）和平均患者天数损失（aPDL）。我们还进行了基于年龄的分层分析，以比较不同年龄的CMVD+错配的相对风险。
■在31,518名CMVD+/R-收件人中，在DDKT后1年，相对死亡风险增加29%(p<0.001)，与匹配的CMVD/R组（N=31,518）相比，移植物衰竭增加了17％（p<0.001）。年龄分层显示，在40岁及以上的患者中，与CMV错配相关的风险显着增加。由于不匹配导致的每个患者的aGDL为125天,并且每个患者的aPDL为100天。
■CMVD+/R-不匹配的风险见于DDKT后1年，并在患者的整个生命周期中累积。平均CMVD+/R-接受者失去超过三个月的DDKT后生存时间。CMVD+/R-不匹配会带来比以前报道的更大的风险和更大的健康负担，从而避免了对更好的预防策略的需要,包括CMV血清定向器官分配,以延长高危患者的寿命和移植物存活.
