222.8: Effect of recurrent CMV viremia on graft and patient survival in renal transplantation.
Notice bibliographique
Résumé
Background: The Genome Canada Precision Medicine Program has shown that cytomegalovirus (CMV) viral load kinetics determine the risk of failure in a large renal transplant cohort with uniform clinical management followed for up to 13 yrs. Here we show that recurrence of CMV viremia, related to CMV risk status, treatment and other factors, has a further profound effect on graft and patient survival. Methods: 2,507 sequential patients who received a renal transplant at UBC from 01/01/08-31/12/08 were followed until 31/12/19 (>6 million patient days of follow-up). 1,441 (57%) received a deceased donor (DD) and 1066 (42%) a live donor (LD) transplant, 2321 (93%) received 1 graft and 186 (7%) >1 graft. All were managed using uniform provincial guidelines for immune suppression and anti-viral therapy. Patients were stratified by donor source, graft number, donor/recipient (D/R) CMV status and CMV viral episode for analysis of graft and patient outcomes. Results: 2,464 patients (98%) had complete data for analysis; 59% were Caucasian, 62% were male, the mean age was 52 ± 15 yrs and CMV strata were D+/R+ (883, 35%), D+/R- (454, 18%), D-/R+ (685, 27%) and D-/R- (442, 18%). Overall, 434 patients developed primary CMV viremia (viral titre: ≥830 IU/ml; range: 1-7 log 10 IU/ml) of whom 67 had recurrent viremia. Recurrent viremia was more common vs no viremia in non-Caucasian (51% vs 39%, p=0.0014), older (mean: 58 vs 51 yr. p<0.0001), D+/R- (45% vs 15%, p<0.0001), and DD graft (78% vs 55%, p<0.0001) recipients, and those receiving antiviral prophylaxis (72% vs 41%, p<0.0001). Multinomial adjusted regression confirmed that increased age, non-Caucasian race, diabetes, D+/R-status and delayed graft function (DGF) were significant predictors of recurrent CMV viremia (p<0.005). Mean peak time from transplant to recurrent CMV infection was 250 days, being shortest in D+/R+ and longest in D-/R- recipients (Figure 1). Mean cumulative event frequency (total viremic episodes by time) reached an asymptote of 21% at 500 days, with rates of 43% in D+/R-, 26% in D+/R+, 14% in D-/R+, and 1% in D-/R- risk groups. Kaplan–Meier analysis found that the probability of the composite endpoint of patient survival with a functioning graft was significantly reduced in patients with recurrent CMV viremia (no CMV viremia 85%, primary CMV viremia 83%, recurrent CMV viremia 63%, p<0.0001; Figure 2). Conclusion: This study confirms that patients with a recurrence of CMV viremia post-transplant are at exceptionally high risk of transplant failure as measured by graft loss or death. The risk of recurrent CMV is related to race, age, donor source and D/R CMV status. Conventional prophylaxis appears to be inadequate to protect these patients from recurrent infection and its serious consequences, indicating that alternative treatment strategies, with continuous long-term monitoring and rapid, effective therapy are of vital importance in these susceptible patients to maximize transplant success.Funding provided by Takeda Development Center Americas, Inc., Genome BC (Genome Canada 273AMR) and the Canadian Institutes of Health Research (CIHR GP1-155871).
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,002 | 0,004 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,001 |
| Bibliométrie | 0,000 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,001 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,001 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,004 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».