title: Everolimus-based immunosuppressive regimens in lung transplant recipients: impact on CMV infection.
abstract: Cytomegalovirus (CMV) is one of the most important viral pathogen in solid organ transplant (SOT) recipients, with heart and lung transplant patients being at considerably high risk for CMV direct and indirect effects. Prevention strategies have resulted in significant reduction in disease and CMV related morbidity and mortality. Few studies reported a lower incidence of CMV infections in solid organ transplant recipients treated with immunosuppressive protocols including the mTOR inhibitor everolimus (EVR).
  
  
  OBJECTIVE
  The aim of the current study was to evaluate the impact of EVR-based immunosuppressive regimens on the occurrence and kinetics of CMV infection in a population of lung transplant recipients, at both systemic and pulmonary level. Thirty-two lung transplants (LT) were investigated; eighteen were on EVR-based immunosuppressive regimens. CMV events occurring in the first two years post-transplantation at both systemic and pulmonary levels were reported.
  
  
  RESULTS
  No differences were reported in CMV viraemia occurrence at both one- and two-year follow up between patients undergoing EVR-based and EVR-free immunosuppressive regimens. Considering CMV episodes at pulmonary levels, as determined by routinely performed broncho-alveolar lavages (BALs), during EVR-administration the patients experienced significantly fewer episodes of high-load CMV (as defined by viral loads⩾10(5) copies/mL) than during EVR-free immunosuppressive regimens.
  
  
  CONCLUSIONS
  EVR-based immunosuppressive regimens in lung transplantation settings appear to be associated to lower incidence of clinically relevant CMV episodes at pulmonary levels, striking the possibility of extending the use of EVR to such a group of transplant recipients.
authors.affiliation: Microbiology and Virology Unit, Laboratory of Virology, University Hospital "Città della Salute e della Scienza di Torino", Via Santena 9, 10126 Torino, Italy; Department of Public Health and Pediatrics, University of Turin, Via Santena 9, 10126 Torino, Italy. Electronic address: massimo.ritta@unito.it.
authors.forename: Massimo
authors.initials: M
authors.lastname: Rittà
authors.affiliation: Microbiology and Virology Unit, Laboratory of Virology, University Hospital "Città della Salute e della Scienza di Torino", Via Santena 9, 10126 Torino, Italy; Department of Public Health and Pediatrics, University of Turin, Via Santena 9, 10126 Torino, Italy. Electronic address: cristina.costa@unito.it.
authors.forename: Cristina
authors.initials: C
authors.lastname: Costa
authors.affiliation: Pneumology Division, University Hospital "Città della Salute e della Scienza di Torino", Corso Bramante 88, 10126 Torino, Italy. Electronic address: psolidoro@cittadellasalute.to.it.
authors.forename: Paolo
authors.initials: P
authors.lastname: Solidoro
authors.affiliation: Microbiology and Virology Unit, Laboratory of Virology, University Hospital "Città della Salute e della Scienza di Torino", Via Santena 9, 10126 Torino, Italy; Department of Public Health and Pediatrics, University of Turin, Via Santena 9, 10126 Torino, Italy. Electronic address: francesca.sidoti@unito.it.
authors.forename: Francesca
authors.initials: F
authors.lastname: Sidoti
authors.affiliation: Pneumology Division, University Hospital "Città della Salute e della Scienza di Torino", Corso Bramante 88, 10126 Torino, Italy. Electronic address: dlibertucci@cittadellasalute.to.it.
authors.forename: Daniela
authors.initials: D
authors.lastname: Libertucci
authors.affiliation: Cardiac Surgery Division, Surgical Sciences Department, University of Turin, University Hospital "Città della Salute e della Scienza di Torino", Torino, Italy. Electronic address: massimo.boffini@unito.it.
authors.forename: Massimo
authors.initials: M
authors.lastname: Boffini
authors.affiliation: Cardiac Surgery Division, Surgical Sciences Department, University of Turin, University Hospital "Città della Salute e della Scienza di Torino", Torino, Italy. Electronic address: mauro.rinaldi@unito.it.
authors.forename: Mauro
authors.initials: M
authors.lastname: Rinaldi
authors.affiliation: Pneumology Division, University Hospital "Città della Salute e della Scienza di Torino", Corso Bramante 88, 10126 Torino, Italy. Electronic address: baldi_sergio@hotmail.com.
authors.forename: Sergio
authors.initials: S
authors.lastname: Baldi
authors.affiliation: Microbiology and Virology Unit, Laboratory of Virology, University Hospital "Città della Salute e della Scienza di Torino", Via Santena 9, 10126 Torino, Italy; Department of Public Health and Pediatrics, University of Turin, Via Santena 9, 10126 Torino, Italy. Electronic address: rossana.cavallo@unito.it.
authors.forename: Rossana
authors.initials: R
authors.lastname: Cavallo
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000998:Antiviral Agents / Q000627:therapeutic use*; D003587:Cytomegalovirus / Q000302:isolation & purification / Q000502:physiology; D003586:Cytomegalovirus Infections / Q000453:epidemiology*; D000068338:Everolimus; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D008168:Lung / Q000821:virology*; D008171:Lung Diseases / Q000453:epidemiology*; D016040:Lung Transplantation; D008297:Male; D008875:Middle Aged; D020123:Sirolimus / Q000031:analogs & derivatives* / Q000627:therapeutic use; D066027:Transplant Recipients; D019562:Viral Load / Q000187:drug effects; D014766:Viremia / Q000453:epidemiology; D055815:Young Adult
chemical_list: D000998:Antiviral Agents; D007166:Immunosuppressive Agents; D000068338:Everolimus; D020123:Sirolimus
keywords: Cytomegalovirus (CMV); Everolimus (EVR); Immunosuppression; Lung transplantation (LT); Opportunistic infections