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

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 ( mTOR i)‐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 mTOR i is useful in patients at high risk of developing CMV infections.