■巨细胞病毒(CMV)感染在肾移植(KTx)后仍然是一个挑战。目前,移植时CMV-IgG血清状态用于个体化CMV预防策略。我们评估了CMV-IGRA预测KTx后CMV感染的临床实用性。
■我们从2016年8月至2022年12月进行了一项全国性的前瞻性队列研究。来自挪威所有成人KTx接受者的数据,n=1,546(R+;n=1,157,D+/R-;n=260,D-/R-;129),共纳入3,556次CMV-IGRA分析(KTx时为1,375次,八周1,188,KTx后一年993)和35,782CMVDNA血症分析。
■在R+接收者CMV-IGRA状态下,在任何时间点测量,无法确定后期CMV感染的任何差异风险。移植后1年保持CMV-IGRA阴性的D+/R-受体(无论当时的CMVDNA血症阳性和/或CMVIgG状态如何)与CMV-IGRA阳性的D+/R-受体相比,晚期CMV感染的风险增加(14%vs.2%,p=0.01)。
■关于移植前CMV-IGRA状态的知识并未提供CMV-IgG血清状态的其他信息,这些信息可以改善当前的移植后CMV治疗算法。然而,移植后1年CMV-IGRA持续阴性的D+/R-受体仍然面临着更高的CMV感染风险。因此,我们主张对这些患者进行移植后CMV-IGRA监测。
UNASSIGNED: Cytomegalovirus (CMV) infection remains a challenge following kidney transplantation (KTx). Currently, CMV-IgG serostatus at transplantation is used to individualize CMV preventive strategies. We assessed the clinical utility of CMV-IGRA for predicting CMV infection following KTx.
UNASSIGNED: We performed a nationwide prospective cohort study from August 2016 until December 2022. Data from all adult KTx recipients in Norway, n=1,546 (R+; n=1,157, D+/R-; n=260, D-/R-; 129), were included with a total of 3,556 CMV-IGRA analyses (1,375 at KTx, 1,188 at eight weeks, 993 one-year after KTx) and 35,782 CMV DNAemia analyses.
UNASSIGNED: In R+ recipients CMV-IGRA status, measured at any of the time-points, could not identify any differential risk of later CMV infection. D+/R- recipients remaining CMV-IGRA negative 1-year after transplantation (regardless of positive CMV DNAemia and/or CMV IgG status at that time) had increased risk of developing later CMV infection compared to D+/R- recipients who had become CMV-IGRA positive (14% vs. 2%, p=0.01).
UNASSIGNED: Knowledge of pre-transplant CMV-IGRA status did not provide additional information to CMV-IgG serostatus that could improve current post-transplant CMV treatment algorithms. However, D+/R- recipients with a persisting negative CMV-IGRA one-year after transplantation remained at increased risk of experiencing later CMV infection. Therefore we advocate post-transplant CMV-IGRA monitoring in these patients.