Reduction in late onset cytomegalovirus primary disease after discontinuation of antiviral prophylaxis in kidney transplant recipients treated with de novo everolimus.

Abstract

BACKGROUND:

Donor (D)+/recipient (R)- serostatus is closely associated with a higher risk of cytomegalovirus (CMV) infection and disease. Antiviral prophylaxis is conventionally used in such patients, but late onset CMV infection/disease still occurs after the discontinuation of prophylaxis.

METHODS:

We retrospectively analyzed the data of 215 low immunological risk patients who received kidney transplantation in our center between 2011 and 2016.

RESULTS:

Ninety-seven patients received a combination of everolimus (EVL)/reduced doses of calcineurin inhibitors (CNI) (EVL group) de novo, and 118 received a combination of mycophenolic acid (MPA)/standard doses of CNI (MPA group) de novo. All patients received induction by basiliximab, steroids, and standardized antiviral prophylaxis depending on their CMV D/R serostatus. D+/R- recipients comprised 17% (n = 16) of the EVL group and 19% (n = 22) of the MPA group (P = .722). In the D+/R- subgroup, the 1-year incidence of late onset CMV primary disease after the withdrawal of prophylaxis was lower in the EVL group than in the MPA group (6% vs 41%, P = .025) while the rate of CMV disease in the D+/R+ group (8% vs 6%, P = 1) and the D-/R+ group (12% vs 9%, P = 1) were similar. Kaplan-Meier analysis of 1-year CMV primary disease-free survival in seronegative patients was significantly better in the EVL group (P = .029, log-rank test).

CONCLUSIONS:

Our data suggest that de novo use of EVL may reduce late onset CMV primary disease after the withdrawal of antiviral prophylaxis in kidney transplantation patients.

• Authors: Arnaud Devresse, Marianne Leruez-Ville, Anne Scemla, Véronique Avettand-Fenoel, Lise Morin, Xavier Lebreton, Claire Tinel, Lucile Amrouche, Lionel Lamhaut, Marc Olivier Timsit, Julien Zuber, Christophe Legendre, Dany Anglicheau
• Journal: Transplant infectious disease : an official journal of the Transplantation Society (Transpl Infect Dis) Vol. 20 Issue 2 Pg. e12846 (Apr 2018) ISSN: 1399-3062 [Electronic] Denmark
• PMID: 29360195 (Publication Type: Journal Article)
• Copyright: © 2018 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Chemical References

• Antiviral Agents
• Immunosuppressive Agents
• Everolimus

Topics

• Adult
• Aged
• Antiviral Agents (administration & dosage, therapeutic use)
• Cohort Studies
• Cytomegalovirus Infections (prevention & control)
• Everolimus (administration & dosage, pharmacology)
• Female
• Graft Rejection (prevention & control)
• Humans
• Immunosuppressive Agents (therapeutic use)
• Kidney Transplantation
• Male
• Middle Aged
• Transplant Recipients