Successful conversion to everolimus after cytomegalovirus infection in a heart transplant recipient.
Cytomegalovirus (CMV) infection remains a major problem in recipients with heart transplantation (HTx), because it may play a significant role in the development of cardiac allograft vasculopathy, which is one of the major causes of death after HTx. Valganciclovir (VGC) is effective for the treatment of CMV infection, but is often associated with neutropenia, especially when used with mycophenolate mophetil (MMF). We experienced an HTx recipient with positive CMV antigenemia who suffered progressive neutropenia after administration of VGC. We switched MMF to everolimus (EVL) and assay for CMV antigenemia was constantly negative even after discontinuation of VGC. In all other 14 HTx recipients who received EVL for any reason, we found that assay for CMV antigenemia remained negative throughout the period of EVL administration. Considering the prophylactic effect on CMV, EVL can not only be an alternative to rescue from comorbidity, but might also be indicated earlier especially in CMV-seronegative HTx recipients.
Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo, Japan.
Teruhiko
T
Imamura
Taro
T
Shiga
Koichiro
K
Kinugawa
Naoko
N
Kato
Miyoko
M
Endo
Toshiro
T
Inaba
Hisataka
H
Maki
Masaru
M
Hatano
Atsushi
A
Yao
Yasunobu
Y
Hirata
Ryozo
R
Nagai
D000328:Adult; D000956:Antigens, Viral / Q000097:blood; D000998:Antiviral Agents / Q000009:adverse effects* / Q000627:therapeutic use*; D003587:Cytomegalovirus / Q000276:immunology; D003586:Cytomegalovirus Infections / Q000188:drug therapy* / Q000821:virology; D057915:Drug Substitution; D004359:Drug Therapy, Combination; D000068338:Everolimus; D015774:Ganciclovir / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000627:therapeutic use; D016027:Heart Transplantation; D006353:Heart-Assist Devices; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects* / Q000627:therapeutic use*; D008297:Male; D009173:Mycophenolic Acid / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000627:therapeutic use; D009503:Neutropenia / Q000139:chemically induced*; D009894:Opportunistic Infections / Q000188:drug therapy* / Q000821:virology; D020123:Sirolimus / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000627:therapeutic use; D000077562:Valganciclovir
D000956:Antigens, Viral; D000998:Antiviral Agents; D007166:Immunosuppressive Agents; D000068338:Everolimus; D000077562:Valganciclovir; D009173:Mycophenolic Acid; D015774:Ganciclovir; D020123:Sirolimus