Cristelli Marina Pontelo, Felipe Claudia Rosso, Prizmic Paulo Sergio de Souza, de Azevedo Vega Figueiredo Dourado, Viana Laila Almeida, Tavares Melissa Gaspar, Wagner de Castro Lima Santos Daniel, de Paula Mayara Ivani, Medina-Pestana Jose Osmar, Tedesco-Silva Junior Helio
Nephrology Division, Hospital do Rim, Federal University of São Paulo, São Paulo, SP, Brazil.
Infectious Disease Division, Hospital do Rim, Federal University of São Paulo, São Paulo, SP, Brazil.
Clin Transplant. 2019 Oct;33(10):e13689. doi: 10.1111/ctr.13689. Epub 2019 Oct 8.
To describe the incidence of cytomegalovirus (CMV) infection/disease in kidney transplant recipients receiving an mTOR-inhibitor-containing immunosuppressive regimen without prophylactic CMV treatment.
This single-center retrospective cohort analysis included all de novo kidney transplant recipients (09/15/2015-07/31/2017) receiving 3 mg/kg single dose of rabbit antithymocyte globulin induction, tacrolimus, everolimus, and prednisone. Preemptive therapy was initiated only in patients deemed at higher risk for CMV infection: (a) D+/R- CMV patients; (b) after treatment for acute rejection (ARt); and (c) after everolimus discontinuation (EVRd).
Of 230 patients, there were no episodes of CMV disease among 217 (94%) without criteria to initiate preemptive therapy. Of 77 (33.5%) patients initiating preemptive therapy, 13 were D+/R-, 30 were ARt, and 34 were EVRd. The overall incidence of first CMV infection/disease was 6% (46.1% in D+/R-, 13.3% ARt [all patients had also discontinued everolimus], and 11.8% after early [<90 days] EVRd). The incidence of biopsy-proven acute rejection was 5.6%, and median glomerular filtration rate at month 12 was 47 mL/min/1.73m . One-year patient and death-censored graft survivals were 97.4% and 98.1%.
This study suggests that everolimus-containing immunosuppressive regimen reduces the need for preventive strategies for CMV infection in the majority of kidney transplant recipients, reducing antiviral drug-associated toxicities and healthcare-related expenditures.
描述在接受含mTOR抑制剂的免疫抑制方案且未进行预防性巨细胞病毒（CMV）治疗的肾移植受者中，CMV感染/疾病的发生率。
这项单中心回顾性队列分析纳入了所有初次接受肾移植的受者（2015年9月15日至2017年7月31日），这些受者接受了3mg/kg单剂量兔抗胸腺细胞球蛋白诱导治疗、他克莫司、依维莫司和泼尼松。仅对被认为CMV感染风险较高的患者启动抢先治疗：（a）D+/R- CMV患者；（b）急性排斥反应治疗后（ARt）；（c）依维莫司停药后（EVRd）。
230例患者中，217例（94%）无启动抢先治疗标准，未发生CMV疾病。在77例（33.5%）启动抢先治疗的患者中，13例为D+/R-，30例为ARt，34例为EVRd。首次CMV感染/疾病的总体发生率为6%（D+/R-患者中为46.1%，ARt患者中为13.3%[所有患者也已停用依维莫司]，早期[<90天]EVRd后为11.8%）。活检证实的急性排斥反应发生率为5.6%，第12个月时的肾小球滤过率中位数为47mL/min/1.73m 。1年的患者和死亡审查后的移植物存活率分别为97.4%和98.1%。
本研究表明，含依维莫司的免疫抑制方案可减少大多数肾移植受者预防CMV感染的策略需求，降低抗病毒药物相关毒性和医疗相关支出。
