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Impact of cytomegalovirus in organ transplant recipients in the era of antiviral prophylaxis
被引:194
作者:
Limaye, Ajit P.
Bakthavatsalam, Ramasamy
Kim, Hyung W.
Randolph, Sara E.
Halldorson, Jeffrey B.
Healey, Patrick J.
Kuhr, Christian S.
Levy, Adam E.
Perkins, James D.
Reyes, Jorge D.
Boeckh, Michael
机构:
[1] Univ Washington, Ctr Med, Dept Lab Med, Seattle, WA 98195 USA
[2] Univ Washington, Dept Med, Seattle, WA 98195 USA
[3] Univ Washington, Dept Surg, Seattle, WA 98195 USA
[4] Fred Hutchinson Canc Res Ctr, Program Infect Dis, Seattle, WA 98104 USA
[5] Univ Washington, Dept Pharm, Seattle, WA 98195 USA
关键词:
cytomegalovirus;
liver transplant;
complications;
mortality;
risk factors;
D O I:
10.1097/01.tp.0000226071.12562.1a
中图分类号:
R392 [医学免疫学];
Q939.91 [免疫学];
学科分类号:
100102 ;
摘要:
Background. Antiviral prophylaxis has been shown to decrease the incidence of cytomegalovirus (CMV) disease in organ transplant recipients, but whether CMV disease that occurs despite prophylaxis is associated with mortality remains unknown. Methods. The clinical features and risk factors for CMV disease in a cohort of liver transplant recipients who received antiviral prophylaxis were assessed retrospectively. Cox proportional hazard regression was used to assess the relationship of CMV to mortality during the first posttransplant year. Results. CMV disease developed in 37 of 437 (8.5%) recipients at a median of 4.5 (range, 2.5 to 12) months posttransplant and was associated only with donor-seropositive/recipient-seronegative serostatus in multivariate analysis (P < 0.0001). Mortality at 1 year was 12% (51 of 437) and was infection-associated in 49% of cases. In multivariate analysis, CMV disease was independently associated with overall mortality at 1 year (HR, 5. 1, P=0.002) and even more strongly with infection-associated mortality (HR 11, P=0.002). There was no association of CMV with noninfection-associated mortality (P > 0.05). Conclusions. Late CMV disease is an important clinical problem in liver transplant recipients who receive antiviral prophylaxis, and is strongly and independently associated with mortality. Strategies to prevent late CMV disease are warranted.
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页码:1645 / 1652
页数:8
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