Association between cytomegalovirus viremia and long-term outcomes in lung transplant recipients
Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved..
Although cytomegalovirus (CMV) viremia/DNAemia has been associated with reduced survival after lung transplantation, its association with chronic lung allograft dysfunction (CLAD) and its phenotypes is unclear. We hypothesized that, in a modern era of CMV prophylaxis, CMV DNAemia would still remain associated with death, but also represent a risk factor for CLAD and specifically restrictive allograft syndrome (RAS)/mixed phenotype. This was a single-center retrospective cohort study of all consecutive adult, first, bilateral-/single-lung transplants done between 2010-2016, consisting of 668 patients. Risks for death/retransplantation, CLAD, or RAS/mixed, were assessed by adjusted cause-specific Cox proportional-hazards models. CMV viral load (VL) was primarily modeled as a categorical variable: undetectable, detectable to 999, 1000 to 9999, and ≥10 000 IU/mL. In multivariable models, CMV VL was significantly associated with death/retransplantation (≥10 000 IU/mL: HR = 2.65 [1.78-3.94]; P < .01), but was not associated with CLAD, whereas CMV serostatus mismatch was (D+R-: HR = 2.04 [1.30-3.21]; P < .01). CMV VL was not associated with RAS/mixed in univariable analysis. Secondary analyses with a 7-level categorical or 4-level ordinal CMV VL confirmed similar results. In conclusion, CMV DNAemia is a significant risk factor for death/retransplantation, but not for CLAD or RAS/mixed. CMV serostatus mismatch may have an impact on CLAD through a pathway independent of DNAemia.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2024 |
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| Erschienen: |
2024 |
| Enthalten in: |
Zur Gesamtaufnahme - year:2024 |
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| Enthalten in: |
American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons - (2024) vom: 01. Feb. |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Kawashima, Mitsuaki [VerfasserIn] |
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| Links: |
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| Themen: |
Bronchiolitis obliterans |
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| Anmerkungen: |
Date Revised 24.02.2024 published: Print-Electronic Citation Status Publisher |
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| doi: |
10.1016/j.ajt.2024.01.027 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM367968002 |
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| 520 | |a Although cytomegalovirus (CMV) viremia/DNAemia has been associated with reduced survival after lung transplantation, its association with chronic lung allograft dysfunction (CLAD) and its phenotypes is unclear. We hypothesized that, in a modern era of CMV prophylaxis, CMV DNAemia would still remain associated with death, but also represent a risk factor for CLAD and specifically restrictive allograft syndrome (RAS)/mixed phenotype. This was a single-center retrospective cohort study of all consecutive adult, first, bilateral-/single-lung transplants done between 2010-2016, consisting of 668 patients. Risks for death/retransplantation, CLAD, or RAS/mixed, were assessed by adjusted cause-specific Cox proportional-hazards models. CMV viral load (VL) was primarily modeled as a categorical variable: undetectable, detectable to 999, 1000 to 9999, and ≥10 000 IU/mL. In multivariable models, CMV VL was significantly associated with death/retransplantation (≥10 000 IU/mL: HR = 2.65 [1.78-3.94]; P < .01), but was not associated with CLAD, whereas CMV serostatus mismatch was (D+R-: HR = 2.04 [1.30-3.21]; P < .01). CMV VL was not associated with RAS/mixed in univariable analysis. Secondary analyses with a 7-level categorical or 4-level ordinal CMV VL confirmed similar results. In conclusion, CMV DNAemia is a significant risk factor for death/retransplantation, but not for CLAD or RAS/mixed. CMV serostatus mismatch may have an impact on CLAD through a pathway independent of DNAemia | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a bronchiolitis obliterans | |
| 650 | 4 | |a cytomegalovirus | |
| 650 | 4 | |a graft rejection | |
| 650 | 4 | |a lung transplantation | |
| 650 | 4 | |a transplantation immunology | |
| 700 | 1 | |a Ma, Jin |e verfasserin |4 aut | |
| 700 | 1 | |a Huszti, Ella |e verfasserin |4 aut | |
| 700 | 1 | |a Levy, Liran |e verfasserin |4 aut | |
| 700 | 1 | |a Berra, Gregory |e verfasserin |4 aut | |
| 700 | 1 | |a Renaud-Picard, Benjamin |e verfasserin |4 aut | |
| 700 | 1 | |a Takahagi, Akihiro |e verfasserin |4 aut | |
| 700 | 1 | |a Ghany, Rasheed |e verfasserin |4 aut | |
| 700 | 1 | |a Sato, Masaaki |e verfasserin |4 aut | |
| 700 | 1 | |a Keshavjee, Shaf |e verfasserin |4 aut | |
| 700 | 1 | |a Singer, Lianne |e verfasserin |4 aut | |
| 700 | 1 | |a Husain, Shahid |e verfasserin |4 aut | |
| 700 | 1 | |a Kumar, Deepali |e verfasserin |4 aut | |
| 700 | 1 | |a Tikkanen, Jussi |e verfasserin |4 aut | |
| 700 | 1 | |a Martinu, Tereza |e verfasserin |4 aut | |
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