Effect of mammalian target of rapamycin inhibitors on cytomegalovirus infection in kidney transplant recipients receiving polyclonal antilymphocyte globulins: a propensity score-matching analysis
Corresponding Author
Carlos Cervera
Division of Infectious Diseases, Department of Medicine, University of Alberta, Edmonton, AB, Canada
Division of Infectious Diseases, IDIBAPS, Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Spain
C.C. and F.C. contributed equally to this work.Correspondence
Dr. Carlos Cervera MD, PhD, 1-124F Clinical Sciences Building, 11350 83 Avenue, Edmonton, AB T6G 2R3, Canada.
Tel.: +1 780-492-6389;
fax: +1 780-492-8050;
e-mail: [email protected]
Search for more papers by this authorFrederic Cofan
Renal Transplantation Unit, Division of Nephrology, IDIBAPS, Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Spain
C.C. and F.C. contributed equally to this work.Search for more papers by this authorCristina Hernandez
Division of Infectious Diseases, Department of Medicine, University of Alberta, Edmonton, AB, Canada
Search for more papers by this authorDolors Soy
Division of Pharmacy, IDIBAPS, Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Spain
Search for more papers by this authorMaria Angeles Marcos
Division of Microbiology, Centre Diagnòstic Biomèdic (CDB), Centre for International Health Research (CRESIB), IDIBAPS, Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Spain
Search for more papers by this authorGemma Sanclemente
Division of Infectious Diseases, Department of Medicine, University of Alberta, Edmonton, AB, Canada
Search for more papers by this authorMarta Bodro
Division of Infectious Diseases, Department of Medicine, University of Alberta, Edmonton, AB, Canada
Search for more papers by this authorAsunción Moreno
Division of Infectious Diseases, Department of Medicine, University of Alberta, Edmonton, AB, Canada
Search for more papers by this authorFritz Diekmann
Renal Transplantation Unit, Division of Nephrology, IDIBAPS, Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Spain
Search for more papers by this authorJosep Maria Campistol
Renal Transplantation Unit, Division of Nephrology, IDIBAPS, Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Spain
Search for more papers by this authorFrederic Oppenheimer
Renal Transplantation Unit, Division of Nephrology, IDIBAPS, Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Spain
Search for more papers by this authorCorresponding Author
Carlos Cervera
Division of Infectious Diseases, Department of Medicine, University of Alberta, Edmonton, AB, Canada
Division of Infectious Diseases, IDIBAPS, Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Spain
C.C. and F.C. contributed equally to this work.Correspondence
Dr. Carlos Cervera MD, PhD, 1-124F Clinical Sciences Building, 11350 83 Avenue, Edmonton, AB T6G 2R3, Canada.
Tel.: +1 780-492-6389;
fax: +1 780-492-8050;
e-mail: [email protected]
Search for more papers by this authorFrederic Cofan
Renal Transplantation Unit, Division of Nephrology, IDIBAPS, Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Spain
C.C. and F.C. contributed equally to this work.Search for more papers by this authorCristina Hernandez
Division of Infectious Diseases, Department of Medicine, University of Alberta, Edmonton, AB, Canada
Search for more papers by this authorDolors Soy
Division of Pharmacy, IDIBAPS, Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Spain
Search for more papers by this authorMaria Angeles Marcos
Division of Microbiology, Centre Diagnòstic Biomèdic (CDB), Centre for International Health Research (CRESIB), IDIBAPS, Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Spain
Search for more papers by this authorGemma Sanclemente
Division of Infectious Diseases, Department of Medicine, University of Alberta, Edmonton, AB, Canada
Search for more papers by this authorMarta Bodro
Division of Infectious Diseases, Department of Medicine, University of Alberta, Edmonton, AB, Canada
Search for more papers by this authorAsunción Moreno
Division of Infectious Diseases, Department of Medicine, University of Alberta, Edmonton, AB, Canada
Search for more papers by this authorFritz Diekmann
Renal Transplantation Unit, Division of Nephrology, IDIBAPS, Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Spain
Search for more papers by this authorJosep Maria Campistol
Renal Transplantation Unit, Division of Nephrology, IDIBAPS, Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Spain
Search for more papers by this authorFrederic Oppenheimer
Renal Transplantation Unit, Division of Nephrology, IDIBAPS, Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Spain
Search for more papers by this authorSummary
Mammalian target of rapamycin inhibitors (mTORi) prevents cytomegalovirus (CMV) infection in kidney transplant (KT) patients. From May 2010 to December 2013, all KT recipients were retrospectively analysed. Maintenance immunosuppression regimen was divided into mTORi or calcineurin inhibitors (CNI)-based regimen. Since June 2011, CMV-seropositive recipients (R+) treated with high-intensity immunosuppression and mTORi did not receive anti-CMV prophylaxis. We analysed 350 consecutive patients, of which 95 (27%) received mTORi and 255 (73%) CNI-based immunosuppression. A Cox-regression multivariate analysis showed that the use of mTORi-based immunosuppression during all follow-up reduced the risk of CMV infection (HR 0.36, 95% CI 0.15–0.89, P = 0.028) and confirmed in a propensity score-matched cohort (HR 0.4, 95% CI 0.1–0.9, P = 0.047). Early discontinuation of mTORi increased the risk of CMV infection (HR 3.2; 95% CI 1.7–6.0) in univariate analysis. The incidence of CMV infection was not higher among CMV R+ patients on mTORi and requiring high-intensity immunosuppression when CMV prophylaxis was not given. The use of mTORi protected for CMV infection in KT patients, allowing to avoid antiviral prophylaxis for R+ patients receiving high-intensity immunosuppression. The increased risk of CMV infection after early discontinuation of mTORi warrants further research.
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