METHODS: This retrospective, matched cohort study included lung transplant recipients who received LET for primary CMV prophylaxis following VGCV intolerance. Patients were matched 1:1 to historical VGCV controls based on age, serostatus group, and time from transplant. The primary outcome was CMV breakthrough within 1 year post-LET initiation; secondary outcomes included hematologic changes.
RESULTS: A total of 124 lung transplant recipients were included per group (32% CMV mismatch, D+R-), with LET initiated a median of 9.6 months post-transplantation. One CMV breakthrough event (0.8%) was observed in the LET group versus four (3.2%) in the VGCV group (p = .370). The median (interquartile range) white blood cell (WBC) count was 3.1 (2.1-5.6) at LET initiation which increased to 5.1 (3.9-7.2) at the end of follow-up (p <.001). For VGCV controls, WBC was 4.8 (3.4-7.2) at baseline and 5.4 (3.6-7.2) at the end of follow-up; this difference was not statistically significant (p = .395). Additionally, 98.4% of LET patients experienced ≥1 leukopenia episode in the year prior to LET compared to 71.8% the year after initiation (p <.001). Similar results were observed for neutropenia (48.4% and 17.7%, p <.001).
CONCLUSIONS: LET prophylaxis was associated with a low rate of CMV reactivation and leukopenia recovery. LET may represent a reasonable prophylaxis option for lung transplant recipients unable to tolerate VGCV.
方法:本回顾性研究,匹配的队列研究包括肺移植受者,这些受者在VGCV不耐受后接受LET治疗以进行CMV初级预防.患者根据年龄与历史VGCV对照1:1匹配,血清状态组,和移植时间。主要结果是在LET开始后1年内CMV突破;次要结果包括血液学变化。
结果:每组共纳入124例肺移植受者(32%CMV不匹配,D+R-),LET在移植后的中位数为9.6个月。在LET组中观察到一个CMV突破事件(0.8%),而在VGCV组中观察到四个(3.2%)(p=.370)。在LET开始时,白细胞(WBC)计数的中位数(四分位距)为3.1(2.1-5.6),在随访结束时增加到5.1(3.9-7.2)(p<.001)。对于VGCV控件,基线时WBC为4.8(3.4-7.2),随访结束时WBC为5.4(3.6-7.2);这种差异没有统计学意义(p=0.395)。此外,98.4%的LET患者在LET前一年经历了≥1次白细胞减少症发作,而在开始后一年为71.8%(p<.001)。中性粒细胞减少症也观察到了类似的结果(48.4%和17.7%,p<.001)。
结论:LET预防与CMV再激活和白细胞减少恢复率低相关。LET可能代表不能耐受VGCV的肺移植受体的合理预防选择。