title: Use of Everolimus-based Immunosuppression to Decrease Cytomegalovirus Infection After Kidney Transplant.
abstract: OBJECTIVE
  Cytomegalovirus infection and disease remain an issue in solid-organ transplant. Universal prophylaxis is more cost-effective than a preemptive strategy and is associated with significantly less Cytomegalovirus resistance after kidney transplant, especially in Cytomegalovirus-seropositive donors and Cytomegalovirus-seronegative recipients.
  
  
  METHODS
  Registry data and meta-analyses have shown that mammalian target of rapamycin inhibitors (sirolimus- and everolimus-based immunosuppression) are associated with significantly less Cytomegalovirus events in de novo kidney transplant patients than in patients who are treated with calcineurin inhibitors plus mycophenolate-based immunosuppression.
  
  
  RESULTS
  Recent pooled analyses of 3 randomized controlled trials in de novo kidney transplant patients, where immunosuppression was based on cyclosporine with either mycophenolate or everolimus, showed that patients who received everolimus had significantly less Cytomegalovirus events (Cytomegalovirus viremia, Cytomegalovirus infection/disease) than those who received mycophenolate, with or without cytomegalovirus as prophylaxis. An even more recent prospective randomized controlled study on de novo kidney transplant patients with no anticytomegalovirus prophylaxis demonstrated that everolimus-based immunosuppression plus low-dose tacrolimus was associated with significantly less Cytomegalovirus infection than standard-dose tacrolimus plus mycophenolate.
  
  
  CONCLUSIONS
  The potential benefits are not fully known of such a therapeutic strategy to limit the long-term indirect effects mediated by Cytomegalovirus infections.
authors.affiliation: From the Clinique Universitaire de Néphrologie, Unité de Transplantation Rénale, CHU Grenoble.
authors.forename: Paolo
authors.initials: P
authors.lastname: Malvezzi
authors.forename: Thomas
authors.initials: T
authors.lastname: Jouve
authors.forename: Lionel
authors.initials: L
authors.lastname: Rostaing
mesh_terms: D003587:Cytomegalovirus / Q000276:immunology* / Q000472:pathogenicity; D004359:Drug Therapy, Combination; D000068338:Everolimus / Q000009:adverse effects / Q000627:therapeutic use*; D019317:Evidence-Based Medicine; D006084:Graft Rejection / Q000201:enzymology / Q000276:immunology / Q000517:prevention & control*; D006085:Graft Survival / Q000187:drug effects*; D054884:Host-Pathogen Interactions; D006801:Humans; D016867:Immunocompromised Host; D007166:Immunosuppressive Agents / Q000009:adverse effects / Q000627:therapeutic use*; D016030:Kidney Transplantation / Q000009:adverse effects*; D009894:Opportunistic Infections / Q000175:diagnosis / Q000276:immunology / Q000517:prevention & control* / Q000821:virology; D047428:Protein Kinase Inhibitors / Q000009:adverse effects / Q000627:therapeutic use*; D012307:Risk Factors; D058570:TOR Serine-Threonine Kinases / Q000037:antagonists & inhibitors / Q000378:metabolism; D013997:Time Factors; D016896:Treatment Outcome; D014775:Virus Activation
chemical_list: D007166:Immunosuppressive Agents; D047428:Protein Kinase Inhibitors; D000068338:Everolimus; C546842:MTOR protein, human; D058570:TOR Serine-Threonine Kinases