Reduction in late onset cytomegalovirus primary disease after discontinuation of antiviral prophylaxis in kidney transplant recipients treated with de novo everolimus. Issue 2 (21st February 2018)

• Record Type: Journal Article
• Authors: Devresse, Arnaud; Leruez‐Ville, Marianne; Scemla, Anne; Avettand‐Fenoel, Véronique; Morin, Lise; Lebreton, Xavier; Tinel, Claire; Amrouche, Lucile; Lamhaut, Lionel; Timsit, Marc Olivier; Zuber, Julien; Legendre, Christophe; Anglicheau, Dany
• Is Part Of: Transplant infectious disease. Volume 20:Issue 2(2018)
• Page Start: n/a
• Page End: n/a
• Publication Date: 2018-02-21
• Subjects: cytomegalovirus -- everolimus -- kidney transplantation -- primary disease; Transplantation of organs, tissues, etc -- Complications -- Periodicals; Communicable diseases -- Periodicals; Infection -- Periodicals; 617.01
• DOI: 10.1111/tid.12846
• Languages: English
• ISSNs: 1398-2273

Abstract

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.