Premium
Effect of mTOR inhibitors during CMV disease in kidney transplant recipients: Results of a pilot retrospective study
Author(s) -
Kaminski Hannah,
Belanger Juliette,
Mary Julien,
Garrigue Isabelle,
Acquier Mathieu,
DéchanetMerville Julie,
Merville Pierre,
Couzi Lionel
Publication year - 2020
Publication title -
microbiology and immunology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.664
H-Index - 70
eISSN - 1348-0421
pISSN - 0385-5600
DOI - 10.1111/1348-0421.12794
Subject(s) - hazard ratio , medicine , proportional hazards model , retrospective cohort study , log rank test , human cytomegalovirus , mycophenolic acid , cytomegalovirus , gastroenterology , confidence interval , betaherpesvirinae , kidney disease , transplantation , immunology , viral disease , herpesviridae , virus
mTOR inhibitors exert a preventive effect on cytomegalovirus (CMV) disease in CMV seropositive (R+) kidney transplant recipients, but their impact during the curative treatment of CMV disease in high‐risk kidney transplant recipients has not been investigated. We aimed to evaluate the efficacy and tolerance of mTOR inhibitors compared with mycophenolic acid in 63 consecutive kidney transplant recipients (80% of D+R−) suffering from CMV disease with a persistent or a recurrent CMV DNAemia. In this monocentric retrospective study, 16 had their treatment converted to mTOR inhibitors and 47 did not. The Kaplan–Meier curves did not show any significant differences in CMV DNAemia eradication (77% vs. 88% respectively; hazard ratio (HR), 1.648 [95% confidence interval (CI), 0.913–2.973]; log‐rank test, P = .132), DNAemia recurrence (36% vs. 47%; HR, 1.517 [95% CI, 0.574–4.007]; log‐rank test, P = .448) and CMV clinical recurrence (17% vs. 27%; HR, 1.375 [95% CI, 0.340–5.552]; log‐rank test, P = .677) between patients who received mTOR inhibitors and those who did not. These results were confirmed in uni‐ and multivariate time‐dependent Cox regressions. In summary, conversion from mycophenolic acid to mTOR inhibitors seems inadequate for improving CMV clearance or in better preventing CMV recurrences during severe or persistent CMV disease.