title: Does the calcineurin inhibitor have influence on cytomegalovirus infection in heart transplantation?
abstract: Cytomegalovirus (CMV) infection is a major cause of morbidity and mortality in heart transplant (HTx). Our aim was to analyze the rate of CMV infection in HTx patients receiving treatment with cyclosporine (CsA) or tacrolimus (Tac). Ninety-five patients were randomized to receive either CsA (53.7%) or Tac (46.3%). We performed prophylaxis with valganciclovir in patients with the highest risk of CMV infection. We considered CMV infection as an increased viral load or the presence of CMV in histological samples. We analyzed baseline characteristics, CMV infection, and other complications. Event-free rates were calculated using the Kaplan-Meier method. There were no significant differences in baseline characteristics between both groups. CMV infection was detected in 31.6% of patients (in 66.7% due to asymptomatic replication). The group treated with Tac had a lower rate of CMV infection (15.9% vs. 45.1%, p = 0.002) and longer CMV infection-free survival time (1440 vs. 899 d, p = 0.001). No differences were observed in the complications analyzed in both groups. The independent risk factors for infection identified in the multivariate analysis were treatment with CsA and bacterial infections. This was the first study to demonstrate a lower rate of CMV infection in patients treated with Tac vs. those treated with CsA after HTx.
authors: Heart Failure and Transplantation Unit, Department of Cardiology, Hospital Universitario y Politécnico La Fe, Valencia, Spain.
authors: María
authors: M
authors: Rodríguez-Serrano
authors: Ignacio
authors: I
authors: Sánchez-Lázaro
authors: Luis
authors: L
authors: Almenar-Bonet
authors: Luis
authors: L
authors: Martínez-Dolz
authors: Manuel
authors: M
authors: Portolés-Sanz
authors: Miguel
authors: M
authors: Rivera-Otero
authors: Antonio
authors: A
authors: Salvador-Sanz
mesh_terms: D000328:Adult; D000998:Antiviral Agents / Q000627:therapeutic use; D065095:Calcineurin Inhibitors; D016572:Cyclosporine / Q000627:therapeutic use; D003587:Cytomegalovirus / Q000187:drug effects / Q000472:pathogenicity; D003586:Cytomegalovirus Infections / Q000188:drug therapy / Q000453:epidemiology*; D005260:Female; D005500:Follow-Up Studies; D015774:Ganciclovir / Q000031:analogs & derivatives / Q000627:therapeutic use; D006084:Graft Rejection / Q000209:etiology / Q000517:prevention & control*; D006085:Graft Survival / Q000187:drug effects; D006333:Heart Failure / Q000150:complications* / Q000601:surgery; D016027:Heart Transplantation; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D011379:Prognosis; D012307:Risk Factors; D015996:Survival Rate; D016559:Tacrolimus / Q000627:therapeutic use; D000077562:Valganciclovir
chemical_list: D000998:Antiviral Agents; D065095:Calcineurin Inhibitors; D007166:Immunosuppressive Agents; D016572:Cyclosporine; D000077562:Valganciclovir; D015774:Ganciclovir; D016559:Tacrolimus
keywords: CMV infection; calcineurin inhibitor; cyclosporine; heart transplantation; tacrolimus