Fewer cytomegalovirus complications after kidney transplantation by de novo use of mTOR inhibitors in comparison to mycophenolic acid
| Autor: | Bjoern Nashan, Martina Koch, Jun Li, Lutz Fischer, Josephine Radtke, Friedrich Thaiss, S Scheidat, N Dietze, V N Spetzler, E-G Achilles |
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| Rok vydání: | 2015 |
| Předmět: |
Adult
Graft Rejection medicine.medical_specialty Basiliximab medicine.medical_treatment Cytomegalovirus 030230 surgery Gastroenterology Mycophenolic acid Cohort Studies 03 medical and health sciences 0302 clinical medicine Internal medicine Medicine Humans Everolimus Risk factor Kidney transplantation Aged Retrospective Studies Immunosuppression Therapy Transplantation business.industry TOR Serine-Threonine Kinases Graft Survival Immunosuppression Odds ratio Middle Aged Mycophenolic Acid medicine.disease Kidney Transplantation Calcineurin Infectious Diseases Immunology Cytomegalovirus Infections 030211 gastroenterology & hepatology business Immunosuppressive Agents medicine.drug |
| Zdroj: | Transplant infectious disease : an official journal of the Transplantation Society. 18(1) |
| ISSN: | 1399-3062 |
| Popis: | Background Cytomegalovirus (CMV) is a risk factor for patient and graft survival after kidney transplantation. Methods We retrospectively analyzed risk factors for CMV 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 (EVE) (n = 47). We also included 82 patients who received more intense immunosuppression (Group 2) with lymphocyte depletion, CNI, plus either MPA (n = 38) or EVE (n = 44). Only patients in the high-risk constellation received CMV prophylaxis in Group 1, while all patients in Group 2 received prophylaxis for 6 month. Results The overall rate of CMV infections was low with 10.1% in all patients. Despite the different prophylaxis strategies applied, no difference was seen in CMV infections between Group 1 (10.9%) and Group 2 (13.6%). A multivariate analysis revealed that patients on EVE had fewer CMV 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 >65 years was an independent risk factor (P = 0.002, OR 3.2, CI 1.5-6.7) for CMV infections. Patients with CMV infections had significantly worse graft function after 2 years (P = 0.001). Conclusion CMV is a significant risk factor for long-term graft outcome. Patients treated with EVE developed fewer CMV complications compared to patients on MPA. The use of mTORi is useful in patients at high risk of developing CMV infections. |
| Databáze: | OpenAIRE |
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