Nephrology Xagena

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De novo use of mTOR inhibitors in comparison to Mycophenolic acid: fewer cytomegalovirus complications after kidney transplantation

Cytomegalovirus ( CMV ) is a risk factor for patient and graft survival after kidney transplantation.

Researchers at University Transplantation-Center ( UTC ), Hamburg ( Germany ), retrospectively analyzed risk factors for Cytomegalovirus infection in 348 patients who received a kidney transplant donated after brain death ( n=232 ) or by living donation ( n=116 ) between 2008 and 2013.

Of the 348 patients analyzed 91 received a mammalian target of rapamycin inhibitor (mTORi)- based immunosuppressive regimen.
A total of 266 patients were treated with standard immunosuppression ( Group 1 ) consisting of Basiliximab induction, calcineurin inhibitor ( CNI ), and either Mycophenolic acid ( MPA, n=219) or Everolimus [ Certican ] ( n=47 ).
They also included 82 patients received more intense immunosuppression ( Group 2 ) with lymphocyte depletion, calcineurin inhibitor, plus either Mycophenolic acid ( n=38 ) or Everolimus ( n=44 ).
Only patients in the high-risk constellation received Cytomegalovirus prophylaxis in Group 1, while all patients in Group 2 received prophylaxis for 6 month.

The overall rate of Cytomegalovirus infections was low with 10.1% in all patients.

Despite the different prophylaxis strategies applied, no difference was seen in Cytomegalovirus infections between Group 1 ( 10.9% ) and Group 2 ( 13.6% ).

A multivariate analysis revealed that patients on Everolimus had fewer Cytomegalovirus complications compared with patients on MPA ( P = 0.013, odds ratio [ OR ] 4.8, confidence interval [ CI ] 1.4-16.5 ).

Donor and recipient age more than 65 years was an independent risk factor ( P = 0.002, OR=3.2, CI 1.5-6.7 ) for Cytomegalovirus infections.

Patients with Cytomegalovirus infections had significantly worse graft function after 2 years ( P = 0.001 ).

In conclusion, Cytomegalovirus is a significant risk factor for long-term graft outcome.
Patients treated with Everolimus developed fewer Cytomegalovirus complications compared to patients on MPA.
The use of mTORi is useful in patients at high risk of developing Cytomegalovirus infections. ( Xagena )

Radtke J et al, Transpl Infect Dis 2015; Epub ahead of print