RESUMO
BACKGROUND: In the absence of an adequate prevention strategy, up to 20% of CMV IgG+ liver transplant recipients (LTR) will develop CMV disease. Despite improved reporting in CMV-DNAemia, there is no consensus as to what the ideal CMV-DNAemia cutoff for a successful preemptive strategy is. Each transplant centre establishes their own threshold. We aimed to determine the effectiveness of our preventive strategy in CMV IgG+ LTR, and evaluate CMV replication kinetics. METHODS: In this retrospective study we determined the incidence of CMV disease in the first 6 months following transplantation in CMV seropositive LTR in a tertiary-care centre in Mexico. Secondary outcomes were determining the number of patients who required preemptive therapy (treatment cutoff ≥ 4000 UI/ml), adherence to the centre's prevention protocol and calculation of viral replication kinetics. RESULTS: One-hundred and twenty-four patients met inclusion criteria. Four patients (3.2%) developed CMV disease. Ninety-six (85%) had detectable DNAemia and 25 (22%) asymptomatic patients received preemptive therapy, none of them developed CMV disease. The highest viral loads were observed on the second posttransplant month. The number of viral load measurements decreased over time. Patients with DNAemia ≥ 4000 UI/ml had a faster viral load growth rate, shorter viral load duplication time, and higher basic reproductive number. Viral load growth rate and autoimmune hepatitis were associated with development of DNAemia ≥ 4000 UI/ml. CONCLUSION: Cytomegalovirus disease occurred in 3.2% of the study subjects. Preemptive therapy using a threshold of CMV ≥ 4000 UI/ml was effective in reducing the incidence of end-organ disease. The viral replication parameters described in this population highlight the importance of frequent monitoring, a challenging feat for transplant programs in low- and middle-income countries.
Assuntos
Infecções por Citomegalovirus , Transplante de Fígado , Antivirais/uso terapêutico , Citomegalovirus/genética , Infecções por Citomegalovirus/tratamento farmacológico , Infecções por Citomegalovirus/epidemiologia , Infecções por Citomegalovirus/prevenção & controle , DNA Viral/genética , Humanos , Incidência , Cinética , México/epidemiologia , Estudos Retrospectivos , Transplantados , Replicação ViralRESUMO
Resumen OBJETIVO: Evaluar si la dilatación del asa intestinal, a partir de los 18 mm, es un factor pronóstico de morbilidad neonatal, debido al debate que aún prevalece acerca de la medición de la dilatación del asa intestinal y su validez como factor pronóstico. MATERIALES Y MÉTODOS: Estudio retrospectivo, transversal y analítico efectuado con los neonatos atendidos de 2013 a 2015. Variables analizadas: dilatación del asa intestinal y tipo de cierre de la pared abdominal como variables de pronóstico de morbilidad neonatal. Para el análisis de los datos se utilizó estadística descriptiva, prueba de U de Mann-Whitney y razón de momios. Se consideró estadísticamente significativo el valor de p ≤ 0.05. RESULTADOS: Se estudiaron 20 neonatos; el grupo con dilatación mayor de 18 mm experimentó complicaciones en 60% de los casos, y el grupo con dilatación ≤ 18 mm solo 13%. Se determinó que la dilatación del asa intestinal mayor de 18 mm es predictora de complicaciones neonatales, con sensibilidad de 85%, especificidad de 58.3% y razón de momios de 8.4 (IC95%: 1-67.8). Los neonatos con cierre primario de la pared abdominal tuvieron menor tiempo de inicio de la vía oral y menos días de nutrición parenteral versus el grupo con silo con un valor p = 0.009 y p = 0.041, respectivamente. La estancia hospitalaria fue similar en ambos grupos (p = 0.069). CONCLUSIÓN: La dilatación del asa intestinal parece ser un factor pronóstico en la predicción de complicaciones neonatales, pero no un factor que pueda predecir los días de estancia intrahospitalaria, el tiempo del inicio de la vía oral o los días de nutrición parenteral en el neonato.
Abstract OBJECTIVE: To assess whether intestinal loop dilatation by prenatal ultrasound is a prognostic factor of neonatal morbidity. MATERIALS AND METHODS: Retrospective analytical cross-sectional study that included cases during the period 2013 to 2015. Variables of intestinal loop dilation and type of abdominal wall closure were analyzed as prognostic variables of neonatal morbidity. For the analysis, descriptive statistics, Mann-Whitney U test and odds ratio were used. The value of p ≤ 0.05 was considered statistically significant. RESULTS: The total population was 20 neonates. The group with dilatation> 18mm presented complications in 60% of the cases, and the group with dilatation ≤ 18mm only 13%; It was determined that intestinal loop dilatation> 18mm is a predictor of neonatal complications with 85% sensitivity, 58.3% specificity and an OR of 8.4 (95%CI: 1-67.8). Neonates in whom primary closure of the abdominal wall was performed had shorter time of oral initiation and fewer days of parenteral nutrition when compared with the group in which Silo was placed, with a value of p = 0.009 and p = 0.041 respectively. While the hospital stay was similar in both groups (p = 0.069). CONCLUSION: Bowel dilation is a prognostic factor in the prediction of neonatal complications, but not a factor that can predict days of in-hospital stay, time of oral initiation or days of parenteral nutrition in the neonate.
