Incidence, risk factors, and outcomes associated with cytomegalovirus disease in small bowel transplant recipients

被引:25
作者
Florescu, D. F. [1 ]
Langnas, A. N. [2 ]
Grant, W. [2 ]
Mercer, D. F. [2 ]
Botha, J. [2 ]
Qiu, F. [3 ]
Shafer, L. [1 ]
Kalil, A. C. [1 ]
机构
[1] Univ Nebraska Med Ctr, Dept Internal Med, Transplant Infect Dis Program, Div Infect Dis, Omaha, NE 68198 USA
[2] Univ Nebraska Med Ctr, Transplant Div, Dept Surg, Omaha, NE 68198 USA
[3] Univ Nebraska Med Ctr, Biostat Dept, Omaha, NE 68198 USA
关键词
cytomegalovirus; small bowel transplantation; infection; disease; pediatric; intestinal transplantation; SOLID-ORGAN TRANSPLANTATION; MYCOPHENOLATE-MOFETIL; INTESTINAL TRANSPLANTATION; INFECTIOUS COMPLICATIONS; KIDNEY-TRANSPLANTATION; RENAL-TRANSPLANTATION; RECEIVING MYCOPHENOLATE; ADENOVIRUS INFECTION; CMV DISEASE; LIVER;
D O I
10.1111/j.1399-3046.2011.01628.x
中图分类号
R72 [儿科学];
学科分类号
100202 ;
摘要
Despite improved prophylaxis, monitoring, and more efficient immunosuppression, CMV infection remains a common opportunistic infection in transplant recipients. We assessed the incidence of CMV disease in pediatric SBT recipients, the timing of CMV disease after transplantation, and its impact on patient outcome. The medical records of 98 SBT recipients were reviewed. We performed descriptive analysis, regression analysis, and Kaplan-Meier curves to determine the time-to-event after transplantation. Fifty-three percent patients were male and 47% female, with a mean age of 38.3 months. Thirty-five percent of patients received prophylactic VGC, 55% GCV, 10% a combination of GCV/VGC, and 99% CMV immunoglobulins. A total of 24.5% recipients were CMV D+/R- (CMV serostatus donor positive/recipient negative). Seven (c. 7%) patients developed CMV disease. CMV disease was associated with 2.5 times (0.52-12.1; p = 0.25) higher rate of CMV mismatch and 11.1 times (1.3-95.9; p = 0.03) higher risk of death. CMV prophylaxis increased time-to-death (p = 0.074). Time-to-CMV disease was shorter in patients with enteritis (p < 0.0001), and CMV disease was associated with shorter time-to-death after transplantation (p = 0.001). CMV disease in SBT recipients was associated with an 11-fold mortality increase and a fourfold faster time-to-death. Time-to-death was significantly shorter with CMV enteritis.
引用
收藏
页码:294 / 301
页数:8
相关论文
共 43 条
[1]   Five Hundred Intestinal and Multivisceral Transplantations at a Single Center Major Advances With New Challenges [J].
Abu-Elmagd, Kareem M. ;
Costa, Guilherme ;
Bond, Geoffrey J. ;
Soltys, Kyle ;
Sindhi, Rakesh ;
Wu, Tong ;
Koritsky, Darlene A. ;
Schuster, Bonita ;
Martin, Littian ;
Cruz, Ruy J. ;
Murase, Noriko ;
Zeevi, Adriana ;
Irish, William ;
Ayyash, Maher O. ;
Matarese, Laura ;
Humar, Abhinav ;
Mazariegos, George .
ANNALS OF SURGERY, 2009, 250 (04) :567-581
[2]   Does mycophenolate mofetil increase the incidence of cytomegalovirus disease compared with azathioprine after cadaveric kidney transplantation? [J].
Basic-Jukic, N ;
Kes, P ;
Bubic-Filipi, LJ ;
Puretic, Z ;
Brunetta, B ;
Pasini, J .
TRANSPLANTATION PROCEEDINGS, 2005, 37 (02) :850-851
[3]   Infections in renal transplant recipients receiving mycophenolate versus azathioprine-based immunosuppression [J].
Bernabeu-Wittel, M ;
Naranjo, M ;
Cisneros, JM ;
Cañas, E ;
Gentil, MA ;
Algarra, G ;
Pereira, P ;
González-Roncero, FJ ;
de Alarcón, A ;
Pachón, J .
EUROPEAN JOURNAL OF CLINICAL MICROBIOLOGY & INFECTIOUS DISEASES, 2002, 21 (03) :173-180
[4]   CMV-hyperimmune globulin for preventing cytomegalovirus infection and disease in solid organ transplant recipients: a meta-analysis [J].
Bonaros, Nikolaos ;
Mayer, Bernd ;
Schachner, Thomas ;
Laufer, Guenther ;
Kocher, Alfred .
CLINICAL TRANSPLANTATION, 2008, 22 (01) :89-97
[5]   Cytomegalovirus infection after intestinal transplantation in children [J].
Bueno, J ;
Green, M ;
Kocoshis, S ;
Furukawa, H ;
AbuElmagd, K ;
Yunis, E ;
Irish, W ;
Todo, S ;
Reyes, J ;
Starzl, TE .
CLINICAL INFECTIOUS DISEASES, 1997, 25 (05) :1078-1083
[6]  
de Maar E F, 2002, Transpl Infect Dis, V4, P17, DOI 10.1034/j.1399-3062.2002.01002.x
[7]  
Dummer JS, 2005, MANDELL DOUGLAS BENN, P2477
[8]   Role of immunosuppressive drugs in the development of tissue-invasive cytomegalovirus infection in renal transplant recipients [J].
Evenepoel, DRJKP ;
Maes, BD ;
Coosemans, W ;
Pirenne, J ;
Vanrenterghem, YFC .
TRANSPLANTATION PROCEEDINGS, 2002, 34 (04) :1164-1170
[9]   Clinical and epidemiological predictors of recurrent cytomegalovirus disease in orthotopic liver transplant recipients [J].
Falagas, ME ;
Snydman, DR ;
Griffith, J ;
Werner, BG ;
Freeman, R ;
Rohrer, R ;
Fairchild, R ;
Fawaz, K ;
Hoffman, MA ;
Kaplan, M ;
Gill, M ;
Rubin, RH ;
Dienstag, JL ;
Doran, M ;
ORourke, E ;
Vacanti, J ;
Jenkins, R ;
Lewis, WD ;
Hammer, S ;
Martin, M ;
Grady, GF ;
Leszczynski, J ;
Dougherty, N ;
Katz, A ;
Fausett, G ;
Platt, R ;
Cheeseman, SH ;
Pasternack, M ;
Gorbach, SL .
CLINICAL INFECTIOUS DISEASES, 1997, 25 (02) :314-317
[10]   Prospective validation of quantitative polymerase chain reaction for management of cytomegalovirus disease in solid-organ transplant patients [J].
Fisher, RA ;
Saggi, BH ;
Ferreira-Gonzalez, A ;
Wolfe, L ;
Posner, MP .
TRANSPLANTATION, 2002, 74 (04) :573-576