目的:评估高危(D+/R-)肾和肝移植受者的巨细胞病毒(CMV)预防后监测。
方法:如果在6/1/15和11/30/22之间进行移植,则包括成年D/R患者,并分为CMV管理前时代(6/1/15-5/31/18),CMV管理时代(6/1/18-6/30/20),和一个监测时代(7/1/2020-11/30/2022),然后持续了12个月。主要目标是评估CMV相关结果。次要目标是按时代评估移植物和患者存活率。
结果:研究期间有328名患者;在管理前时代有133名患者,103在管理时代,和92在监视时代。监测时代的复制率明显更高,如预期的那样,由于抽样增加(前38.4%,管理权33.0%,监测52.2%,p=0.02)。从移植到第一次复制的时间相似(前214.0±79.0天,管理231.1±65.5,监测234.9±61.4,p=0.29)。CMV病毒载量(VL)首次检测,最大值-VL,在监测时代,VL>100000IU/mL的发生率在数字上较低,虽然没有统计学意义。CMV终末器官疾病(p<0.0001)和更昔洛韦耐药性(p=0.002)在监测时代明显低于之前两个时代。不同时代的拒绝没有差异(p=0.4)。在监测时代,移植物(p=0.0007)和患者生存率(p=0.008)显着改善。
结论:预防后监测可显著降低CMV终末器官疾病和耐药性。尽管在监测时代观察到复制率增加,排斥反应无显著差异,12个月时无移植物丢失或患者死亡.
OBJECTIVE: Evaluate cytomegalovirus (CMV) post-prophylaxis surveillance in high-risk (D+/R-) kidney and liver transplant recipients.
METHODS: Adult D+/R- patients were included if transplanted between 6/1/15 and 11/30/22 and divided into a pre-CMV-stewardship-era (6/1/15-5/31/18), CMV-stewardship-era (6/1/18-6/30/20), and a surveillance-era (7/1/2020-11/30/2022) then followed through 12 months. The primary objective was to evaluate CMV-related outcomes. The secondary objective was to assess graft and patient survival by era.
RESULTS: There were 328 patients in the study period; 133 in the pre-stewardship-era, 103 in the stewardship-era, and 92 in the surveillance-era. Replication rates in the surveillance-era were significantly higher, as anticipated due to increased sampling (pre 38.4%, stewardship 33.0%, surveillance 52.2%, p = 0.02). Time from transplant to first replication was similar (pre 214.0 ± 79.0 days, stewardship 231.1 ± 65.5, surveillance 234.9 ± 61.4, p = 0.29). CMV viral load (VL) at first detection, maximum-VL, and incidence of VL > 100 000 IU/mL were numerically lower in the surveillance era, although not statistically significant. CMV end-organ disease (p < 0.0001) and ganciclovir-resistance (p = 0.002) were significantly lower in the surveillance era than in both previous eras. Rejection was not different between eras (p = 0.4). Graft (p = 0.0007) and patient survival (p = 0.008) were significantly improved in the surveillance era.
CONCLUSIONS: Post-prophylaxis surveillance significantly reduced CMV end-organ disease and resistance. Despite observing increased replication rates in the surveillance era, rejection was not significantly different and there was no graft loss or patient mortality at 12 months.