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.
Pneumology Division, University Hospital "Città della Salute e della Scienza di Torino", Corso Bramante 88, 10126 Torino, Italy.
Antiviral Res. 2015 Jan;113:19-26. doi: 10.1016/j.antiviral.2014.10.016. Epub 2014 Nov 7.
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).
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.
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.
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.
巨细胞病毒 (CMV) 是实体器官移植 (SOT) 受者中最重要的病毒病原体之一，心脏和肺移植患者面临着相当高的 CMV 直接和间接影响的风险。预防策略已显著降低了疾病和 CMV 相关发病率和死亡率。少数研究报告称，接受包括 mTOR 抑制剂依维莫司 (EVR) 在内的免疫抑制方案治疗的实体器官移植受者中 CMV 感染的发生率较低。
本研究的目的是评估基于 EVR 的免疫抑制方案对肺移植受者人群中 CMV 感染的发生和动力学的影响，包括全身和肺部水平。研究了 32 例肺移植 (LT)；其中 18 例接受了基于 EVR 的免疫抑制方案。报告了移植后前两年全身和肺部水平发生的 CMV 事件。
在 1 年和 2 年的随访中，接受基于 EVR 和无 EVR 免疫抑制方案的患者的 CMV 病毒血症发生率没有差异。考虑到通过常规支气管肺泡灌洗 (BAL) 在肺部水平确定的 CMV 发作，在 EVR 给药期间，患者经历的高负荷 CMV 发作（定义为病毒载量 ⩾10(5) 拷贝/mL）明显少于无 EVR 免疫抑制方案。
在肺移植环境中，基于 EVR 的免疫抑制方案似乎与肺部水平更常见的临床相关 CMV 发作发生率较低相关，这使得将 EVR 扩展到此类移植受者成为可能。
