title: Effect of mammalian target of rapamycin inhibitors on cytomegalovirus infection in kidney transplant recipients receiving polyclonal antilymphocyte globulins: a propensity score-matching analysis.
abstract: Mammalian target of rapamycin inhibitors (mTORi) prevents cytomegalovirus (CMV) infection in kidney transplant (KT) patients. From May 2010 to December 2013, all KT recipients were retrospectively analysed. Maintenance immunosuppression regimen was divided into mTORi or calcineurin inhibitors (CNI)-based regimen. Since June 2011, CMV-seropositive recipients (R+) treated with high-intensity immunosuppression and mTORi did not receive anti-CMV prophylaxis. We analysed 350 consecutive patients, of which 95 (27%) received mTORi and 255 (73%) CNI-based immunosuppression. A Cox-regression multivariate analysis showed that the use of mTORi-based immunosuppression during all follow-up reduced the risk of CMV infection (HR 0.36, 95% CI 0.15-0.89, P = 0.028) and confirmed in a propensity score-matched cohort (HR 0.4, 95% CI 0.1-0.9, P = 0.047). Early discontinuation of mTORi increased the risk of CMV infection (HR 3.2; 95% CI 1.7-6.0) in univariate analysis. The incidence of CMV infection was not higher among CMV R+ patients on mTORi and requiring high-intensity immunosuppression when CMV prophylaxis was not given. The use of mTORi protected for CMV infection in KT patients, allowing to avoid antiviral prophylaxis for R+ patients receiving high-intensity immunosuppression. The increased risk of CMV infection after early discontinuation of mTORi warrants further research.
authors: Division of Infectious Diseases, Department of Medicine, University of Alberta, Edmonton, AB, Canada. cerveraa@ualberta.ca.|Division of Infectious Diseases, IDIBAPS, Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Spain. cerveraa@ualberta.ca.
authors: Carlos
authors: C
authors: Cervera
authors: Renal Transplantation Unit, Division of Nephrology, IDIBAPS, Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Spain.
authors: Frederic
authors: F
authors: Cofan
authors: Division of Infectious Diseases, Department of Medicine, University of Alberta, Edmonton, AB, Canada.
authors: Cristina
authors: C
authors: Hernandez
authors: Division of Pharmacy, IDIBAPS, Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Spain.
authors: Dolors
authors: D
authors: Soy
authors: Division of Microbiology, Centre Diagnòstic Biomèdic (CDB), Centre for International Health Research (CRESIB), IDIBAPS, Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Spain.
authors: Maria Angeles
authors: MA
authors: Marcos
authors: Division of Infectious Diseases, Department of Medicine, University of Alberta, Edmonton, AB, Canada.
authors: Gemma
authors: G
authors: Sanclemente
authors: Division of Infectious Diseases, Department of Medicine, University of Alberta, Edmonton, AB, Canada.
authors: Marta
authors: M
authors: Bodro
authors: Division of Infectious Diseases, Department of Medicine, University of Alberta, Edmonton, AB, Canada.
authors: Asunción
authors: A
authors: Moreno
authors: Renal Transplantation Unit, Division of Nephrology, IDIBAPS, Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Spain.
authors: Fritz
authors: F
authors: Diekmann
authors: Renal Transplantation Unit, Division of Nephrology, IDIBAPS, Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Spain.
authors: Josep Maria
authors: JM
authors: Campistol
authors: Renal Transplantation Unit, Division of Nephrology, IDIBAPS, Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Spain.
authors: Frederic
authors: F
authors: Oppenheimer
mesh_terms: D000328:Adult; D000368:Aged; D000961:Antilymphocyte Serum / Q000627:therapeutic use*; D065095:Calcineurin Inhibitors / Q000627:therapeutic use; D003586:Cytomegalovirus Infections / Q000188:drug therapy / Q000517:prevention & control*; D005260:Female; D006801:Humans; D007165:Immunosuppression Therapy; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D057216:Propensity Score; D016016:Proportional Hazards Models; D051437:Renal Insufficiency / Q000601:surgery*; D012189:Retrospective Studies; D012306:Risk; D020123:Sirolimus / Q000627:therapeutic use; D013030:Spain; D058570:TOR Serine-Threonine Kinases / Q000037:antagonists & inhibitors*
chemical_list: D000961:Antilymphocyte Serum; D065095:Calcineurin Inhibitors; D007166:Immunosuppressive Agents; C546842:MTOR protein, human; D058570:TOR Serine-Threonine Kinases; D020123:Sirolimus
keywords: cytomegalovirus; kidney transplantation; mammalian target of rapamycin inhibitors; polyclonal anti-lymphocyte globulins