Use of mTOR inhibitor as prophylaxis for cytomegalovirus disease after kidney transplantation: A natural experiment

• Published in: Clinical transplantation 2019-10, Vol.33 (10), p.e13689-n/a
• Main Authors: Cristelli, Marina Pontelo, Felipe, Claudia Rosso, Prizmic, Paulo Sergio de Souza, Azevedo, Vega Figueiredo Dourado, Viana, Laila Almeida, Tavares, Melissa Gaspar, Wagner de Castro Lima Santos, Daniel, Paula, Mayara Ivani, Medina‐Pestana, Jose Osmar, Tedesco‐Silva Junior, Helio
• Format: Article
• Language: English
• Subjects: antibiotic prophylaxis; clinical trial design; cytomegalovirus; infection and infectious agents; mTOR inhibitors
• ISSN: 0902-0063; 1399-0012
• DOI: 10.1111/ctr.13689

Objectives To describe the incidence of cytomegalovirus (CMV) infection/disease in kidney transplant recipients receiving an mTOR‐inhibitor‐containing immunosuppressive regimen without prophylactic CMV treatment. Methods This single‐center retrospective cohort analysis included all de novo kidney transplant recipients (09/15/2015‐07/31/2017) receiving 3 mg/kg single dose of rabbit antithymocyte globulin induction, tacrolimus, everolimus, and prednisone. Preemptive therapy was initiated only in patients deemed at higher risk for CMV infection: (a) D+/R− CMV patients; (b) after treatment for acute rejection (ARt); and (c) after everolimus discontinuation (EVRd). Results Of 230 patients, there were no episodes of CMV disease among 217 (94%) without criteria to initiate preemptive therapy. Of 77 (33.5%) patients initiating preemptive therapy, 13 were D+/R−, 30 were ARt, and 34 were EVRd. The overall incidence of first CMV infection/disease was 6% (46.1% in D+/R−, 13.3% ARt [all patients had also discontinued everolimus], and 11.8% after early [