Publication: Monitorización periódica de la carga viral del virus de Epstein-Barr en sangre como marcador del grado de inmunosupresión y del riesgo de infección en portadores de trasplante de pulmón
Loading...
Files
Official URL
Full text at PDC
Publication Date
2017-09-15
Advisors (or tutors)
Editors
Journal Title
Journal ISSN
Volume Title
Publisher
Universidad Complutense de Madrid
Citations
Exportar
Abstract
Estudios recientes sugieren que la viremia del Virus Epstein-Barr (VEBd) puede actuar como un marcador de grado de inmunosupresión en portadores de trasplante de órgano sólido. Esta hipótesis no ha sido probada hasta ahora en el trasplante de pulmón (TP). Objetivos: Estudiar la historia natural de VEB en el TP y valorar la relación entre la detección de VEB en sangre periférica y el desarrollo de infecciones, rechazo agudo y rechazo crónico. Pacientes y Métodos: Se incluyeron a 63 pacientes sometidos a TP en el Hospital Universitario 12 de Octubre entre Octubre de 2008 y Mayo de 2013. La VEBd se evaluó por RT-PCR de manera trimestral. La aparición de complicaciones tardías (disfunción crónica del injerto pulmonar [DCIP], cualquier infección o infección oportunista [IO]) se analizó en función de la detección de la VEBd dentro de los primeros seis meses tras el trasplante. Resultados: Se detectó VEBd en 30 pacientes (47,6%). El pico VEBd fue mayor en pacientes con cualquier tipo de infección tardía (2,23 vs 1,73 log10 copias/mL; P = 0,026) e IO tardía (2,39 vs 1,74 log10 copias/mL; P = 0,004). La presencia de VEBd ≥2 log10 copias/mL en los primeros seis meses después del trasplante se asoció con un mayor riesgo de IO tardía (Hazard ratio ajustado [aHR]: 7,92; intervalo de confianza [IC] del 95%: 2,10-29,85; P = 0,002). Los receptores con VEBd detectable durante los primeros 6 meses tras el trasplante también tuvieron un menor periodo libre de DCIP (P = 0,035), aunque esta asociación no se mantuvo estadísticamente significativo en el análisis multivariante (aHR: 1,26; IC 95%: 0,87-5,29; P = 0,099). Conclusiones: La detección de VEBd dentro de los primeros 6 meses después del TP es frecuente. Nuestros resultados sugieren que este fenómeno se correlaciona con la aparición de complicaciones tardías en el post-trasplante.
Recent studies suggest that Epstein-Barr Virus viremia (EBVd) can act as a marker of immunosuppression in the post-transplant period. This hypothesis has not been proven so far in lung transplantation (LT). Objectives: To study the natural history of EBV in LT and assess the relationship between the detection of EBV in peripheral blood and the development of infections, acute rejection and chronic rejection. Patients and Methods: 63 patients undergoing LT in the University Hospital “12 de Octubre” between October 2008 and May 2013 were included. EBVd was assessed by RT-PCR on a quarterly basis. The occurrence of late complications (chronic lung allograft dysfunction [CLAD] and any infection or opportunistic infection [OI], respectively) was analyzed according to the detecting of EBVd within the first six months after transplantation. Results: EBVd was detected in 30 patients (47.6%). The EBVd peak was higher in patients with late systemic infection (2.23 vs 1.73 log10 copies/mL; P = 0.026) and late OI (2.39 vs 1.74 log10 copies/mL; P = 0.004). The presence of EBVd ≥2 log10 copies/mL in the first six months after transplantation was associated with an increased risk of late OI (adjusted hazard ratio [aHR]: 7.92; confidence interval [CI] 95%: 2.10 -29.85, P = 0.002). Recipients with EBVd during the first six months also had a smaller CLAD free period (P = 0.035), although this association was not statistically significant in the multivariate analysis (aHR: 1.26; 95% CI: 0,87- 5.29; P = 0.099). Conclusions: The detection of EBVd within the first 6 months after LT is common. Our results suggest that this phenomenon shows correlation with the appearance of post-transplant late complications.
Recent studies suggest that Epstein-Barr Virus viremia (EBVd) can act as a marker of immunosuppression in the post-transplant period. This hypothesis has not been proven so far in lung transplantation (LT). Objectives: To study the natural history of EBV in LT and assess the relationship between the detection of EBV in peripheral blood and the development of infections, acute rejection and chronic rejection. Patients and Methods: 63 patients undergoing LT in the University Hospital “12 de Octubre” between October 2008 and May 2013 were included. EBVd was assessed by RT-PCR on a quarterly basis. The occurrence of late complications (chronic lung allograft dysfunction [CLAD] and any infection or opportunistic infection [OI], respectively) was analyzed according to the detecting of EBVd within the first six months after transplantation. Results: EBVd was detected in 30 patients (47.6%). The EBVd peak was higher in patients with late systemic infection (2.23 vs 1.73 log10 copies/mL; P = 0.026) and late OI (2.39 vs 1.74 log10 copies/mL; P = 0.004). The presence of EBVd ≥2 log10 copies/mL in the first six months after transplantation was associated with an increased risk of late OI (adjusted hazard ratio [aHR]: 7.92; confidence interval [CI] 95%: 2.10 -29.85, P = 0.002). Recipients with EBVd during the first six months also had a smaller CLAD free period (P = 0.035), although this association was not statistically significant in the multivariate analysis (aHR: 1.26; 95% CI: 0,87- 5.29; P = 0.099). Conclusions: The detection of EBVd within the first 6 months after LT is common. Our results suggest that this phenomenon shows correlation with the appearance of post-transplant late complications.
Description
Tesis inédita de la Universidad Complutense de Madrid, Facultad de Medicina, Departamento de Medicina, leída el 28/06/2016