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Does the calcineurin inhibitor have influence on cytomegalovirus infection in heart transplantation?
Author(s) -
RodríguezSerrano María,
SánchezLázaro Ignacio,
AlmenarBonet Luis,
MartínezDolz Luis,
PortolésSanz Manuel,
RiveraOtero Miguel,
SalvadorSanz Antonio
Publication year - 2014
Publication title -
clinical transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.918
H-Index - 76
eISSN - 1399-0012
pISSN - 0902-0063
DOI - 10.1111/ctr.12282
Subject(s) - medicine , cytomegalovirus , asymptomatic , valganciclovir , calcineurin , heart transplantation , tacrolimus , gastroenterology , cytomegalovirus infection , transplantation , immunology , human cytomegalovirus , viral disease , herpesviridae , virus
Cytomegalovirus ( CMV ) infection is a major cause of morbidity and mortality in heart transplant ( HT x). Our aim was to analyze the rate of CMV infection in HT x patients receiving treatment with cyclosporine ( C s A ) or tacrolimus (Tac). Ninety‐five patients were randomized to receive either C s A (53.7%) or Tac (46.3%). We performed prophylaxis with valganciclovir in patients with the highest risk of CMV infection. We considered CMV infection as an increased viral load or the presence of CMV in histological samples. We analyzed baseline characteristics, CMV infection, and other complications. Event‐free rates were calculated using the Kaplan‐Meier method. There were no significant differences in baseline characteristics between both groups. CMV infection was detected in 31.6% of patients (in 66.7% due to asymptomatic replication). The group treated with Tac had a lower rate of CMV infection (15.9% vs. 45.1%, p = 0.002) and longer CMV infection‐free survival time (1440 vs. 899 d, p = 0.001). No differences were observed in the complications analyzed in both groups. The independent risk factors for infection identified in the multivariate analysis were treatment with C s A and bacterial infections. This was the first study to demonstrate a lower rate of CMV infection in patients treated with Tac vs. those treated with C s A after HT x.