Tuesday, March 8, 2016

Fewer cytomegalovirus complications after kidney transplantation by de novo use of mTOR inhibitors in comparison to mycophenolic acid - Radtke - 2016 - Transplant Infectious Disease - Wiley Online Library

onlinelibrary.wiley.com Fewer cytomegalovirus complications after kidney transplantation by de novo use of mTOR inhibitors in comparison to mycophenolic acid - Radtke - 2016 - Transplant Infectious Disease - Wiley Online Library

Original Report

Fewer cytomegalovirus complications after kidney transplantation by de novo use of mTOR inhibitors in comparison to mycophenolic acid

  1. J. Radtke1,†,
  2. N. Dietze1,†,
  3. V.N. Spetzler1,
  4. L. Fischer1,
  5. E.-G. Achilles1,
  6. J. Li1,
  7. S. Scheidat2,
  8. F. Thaiss2,
  9. B. Nashan1 and
  10. M. Koch1,*

Article first published online: 3 FEB 2016

DOI: 10.1111/tid.12494

© 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd

Issue

Transplant Infectious Disease

Volume 18, Issue 1, pages 79–88, February 2016


Additional Information

How to Cite

J. Radtke, N. Dietze, V.N. Spetzler, L. Fischer, E.-G. Achilles, J. Li, S. Scheidat, F. Thaiss, B. Nashan, M. Koch. Fewer cytomegalovirus complications after kidney transplantation by de novo use of mTOR inhibitors in comparison to mycophenolic acid. Transpl Infect Dis 2016: 18: 7988. All rights reserved

Author Information

  1. 1

    Department of Hepatobiliary and Transplant Surgery, University Medical Center Hamburg-Eppendorf UKE, University Transplantation-Center UTC, Hamburg, Germany

  2. 2

    Department of Internal Medicine III, University Medical Center Hamburg-Eppendorf UKE, University Transplantation-Center UTC, Hamburg, Germany

  1. These authors contributed equally to this article.

* Correspondence to:
Prof. Martina Koch, Department of Hepatobiliary and Transplant Surgery, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany
Tel: +(0)-40-7410-56137
Fax: + (0)-40-7410-40051
E-mail: martina.koch@uke.de

Publication History

  1. Issue published online: 15 FEB 2016
  2. Article first published online: 3 FEB 2016
  3. Accepted manuscript online: 27 DEC 2015 10:41PM EST
  4. Manuscript Accepted: 17 OCT 2015
  5. Manuscript Revised: 10 OCT 2015
  6. Manuscript Revised: 11 SEP 2015
  7. Manuscript Received: 29 JUL 2015

Funded by

  • Novartis
  • Astellas

Keywords:

  • cytomegalovirus;
  • CMV prophylaxis;
  • kidney transplantation;
  • immunosuppression;
  • everolimus;
  • mTOR inhibitors

Abstract

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.




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