157
￭♣ Sat-203 ￭
Clinical significance and natural history of NB-type NTM lung disease according to cavity
1울산대학교 의과대학 서울아산병원 내과, 2울산대학교 의과대학 서울아산병원 호흡기내과
*
한동우
1, 권병수
2, 심태선
1,2Background/Aims: Nontuberculous mycobacterial (NTM) pulmonary disease is categorized into fibrocavitary and nodular bronchiectatic (NB) type.
Approximately 12 - 25% of patients with NB-type disease have cavitary lesions and show poor prognosis. We aimed to investigate the cavity formation during follow-up in patients with NB-type Mycobacterium avium complex (MAC) pulmonary disease. Methods: Among patients with NB-type MAC dis- ease, non-cavitary patients at baseline (Baseline-CN) were followed-up and the development of cavity was monitored retrospectively. Clinical outcome and the predictors of cavity development were evaluated. Results: Among 882 patients with NB-type MAC pulmonary disease, 143 (16.2%) had cavities at di- agnosis (Baseline-CP). Among 601 Baseline-CN patients, cavity had eventually developed in 51 patients (8.4%) during a median 49.6 months of follow up (F/U-CP group). Baseline-CP patients had lower body mass index (BMI), higher pack.years, higher number of involved lobes, more history of tuberculosis (TB), concomitant pulmonary disease, more M. intracellulare, and positive AFB smear at diagnosis (Table 1). When compared to patients who were non-cavitary until the end of study period (F/U-CN group), F/U-CP patients showed significant differences in terms of BMI, history of TB, MAC species, positive AFB smear at diagnosis (Table 2). On univariate logistic regression analyses, BMI (odds ratio (OR) 0.87, 95% confidence interval (CI) 0.79–0.97, p-value=0.01), M. intracellulare (OR 2.29, 95% CI 1.27–4.12, p-value=0.01), positive AFB smear at diagnosis (OR 1.81, 95% CI 1.01–3.27, p-value=0.05) were predictors of developing cavitary lesions. Conclusions: In our cohort, 16.2% of NB-type MAC pulmonary disease had cavities at diagnosis and 8.4%
(51/601) developed cavity during follow-up. Cavity presence at baseline or on follow-up may have an impact on clinical outcomes. Thus, patients with high probability of cavity formation, such as low BMI, M. intracellulare, or positive AFB smear at diagnosis, need closer follow up for their disease progression.
￭♣ Sat-204 ￭
Risk factors for cytomegalovirus (CMV) reactivation in lung transplant recipients
1연세대학교 의과대학 내과학교실, 세브란스병원 호흡기내과, 2연세대학교 의과대학 흉부외과학교실, 세브란스병원 흉부외과,
3연세대학교 의과대학 내과학교실, 세브란스병원 감염내과
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곽세현
1, 문성우
1, 정수진
3, 박무석
1, 이진구
2, 백효채
2, 김송이
1Background/Aims: Cytomegalovirus (CMV) is the most important and frequent viral infections after transplantation. To prevent CMV infection, prophy- laxis therapy (Administration of Intravenous or oral ganciclovir, valganciclovir) is recommended to continue for 90 to 180 days. Despite of prophylaxis therapy, CMV reactivation remains occur from 6 months after lung transplantation (LTx). Thus, we aimed to study the risk factors for CMV reactivation among patients who underwent lung transplantation. Methods: We performed a single-center retrospective study including all patients who underwent LTx between 2013.1.1~2017.5 in one tertiary care hospital in South Korea. We included the patients who survived more than one year after LTx. Patients were monitored for CMV replication regulary in the blood by PCR, and “CMV reactivation” was defined as CMV PCR above 3000 copies/mL in our program. Results: One hundred forty two patients were underwent lung transplantation. Among them, 89 patients met the inclusion criteria. Of the 89 pa- tients, 39 patients (43.8%) had post-transplant CMV reactivation (CMV + group) and 50 patients (56.2%) did not have an episode of CMV reactivation (CMV – group). The median age at transplantation was 53 (range 16-75) years, and the sex distribution, BMI, and underlying lung disease were similar be- tween CMV + and CMV - groups. In the univariable analysis, use of more than 0.5mg/kg/day of steroids, incompletion of antiviral prophylaxis, lymphocy- topenia (less than 1000 lymphocytes per microliter of blood) within 6 months, pneumonia, and urinary tract infection were associated with CMV reactivation. In multivariate analysis, lymphocytopenia (less than 1000 lymphocytes per microliter of blood) within 6 months was statistical significantly associated with CMV reactivation. (OR 32.57, P=0.002) Conclusions: Out data suggest that lymphocytopenia is probably associated with an increased risk of CMV reactivation after LTx. Clinician should close follow up the patients who have low lymphocyte after LTx.
