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Reduction in late onset cytomegalovirus primary disease after discontinuation of antiviral prophylaxis in kidney transplant recipients treated with de novo everolimus
Author(s) -
Devresse Arnaud,
LeruezVille Marianne,
Scemla Anne,
AvettandFenoel Véronique,
Morin Lise,
Lebreton Xavier,
Tinel Claire,
Amrouche Lucile,
Lamhaut Lionel,
Timsit Marc Olivier,
Zuber Julien,
Legendre Christophe,
Anglicheau Dany
Publication year - 2018
Publication title -
transplant infectious disease
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.69
H-Index - 67
eISSN - 1399-3062
pISSN - 1398-2273
DOI - 10.1111/tid.12846
Subject(s) - medicine , basiliximab , serostatus , discontinuation , gastroenterology , everolimus , calcineurin , transplantation , immunosuppression , cytomegalovirus , mycophenolic acid , kidney transplantation , immunology , viral load , viral disease , virus , herpesviridae
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.