Impact of Everolimus and Low-Dose Cyclosporin on Cytomegalovirus Replication and Disease in Pediatric Renal Transplantation

被引：34

作者：

Hoecker, B. ^{[1
]}

Zencke, S. ^{[1
]}

Pape, L. ^{[2
]}

Krupka, K. ^{[1
]}

Koester, L. ^{[1
,3
]}

Fichtner, A. ^{[1
]}

Dello Strologo, L. ^{[4
]}

Guzzo, I. ^{[4
]}

Topaloglu, R. ^{[5
]}

Kranz, B. ^{[6
]}

Koenig, J. ^{[6
]}

Bald, M. ^{[7
]}

Webb, N. J. A. ^{[8
]}

Noyan, A. ^{[9
]}

Dursun, H. ^{[9
]}

Marks, S. ^{[10
]}

Ozcakar, Z. B. ^{[11
]}

Thiel, F. ^{[12
]}

Billing, H. ^{[13
]}

Pohl, M. ^{[14
]}

Fehrenbach, H. ^{[15
]}

Schnitzler, P. ^{[16
]}

Bruckner, T. ^{[3
]}

Ahlenstiel-Grunow, T. ^{[2
]}

Toenshoff, B. ^{[1
]}

机构：

[1] Univ Childrens Hosp, Dept Pediat 1, Heidelberg, Germany

[2] Hannover Med Sch, Hannover, Germany

[3] Heidelberg Univ, Inst Med Biometry & Informat, Heidelberg, Germany

[4] IRCCS Osped Pediat Bambino Gesu, Rome, Italy

[5] Hacettepe Univ, Fac Med, Dept Pediat Nephrol, TR-06100 Ankara, Turkey

[6] Univ Childrens Hosp, Dept Gen Pediat, Pediat Nephrol, Munster, Germany

[7] Olga Childrens Hosp, Clin Stuttgart, Stuttgart, Germany

[8] Cent Manchester Univ Hosp NHS Fdn Trust, Manchester Acad Hlth Sci Ctr, Royal Manchester Childrens Hosp, Manchester, Lancs, England

[9] Baskent Univ, Adana Teaching & Res Ctr, Dept Pediat Nephrol, Adana, Turkey

[10] Great Ormond St Hosp Sick Children, London, England

[11] Ankara Univ, Fac Med, TR-06100 Ankara, Turkey

[12] Univ Childrens Hosp, Hamburg, Germany

[13] Univ Childrens Hosp, Tubingen, Germany

[14] Univ Childrens Hosp, Freiburg, Germany

[15] Childrens Hosp, Memmingen, Germany

[16] Univ Heidelberg Hosp, Dept Infect Dis, Virol, Heidelberg, Germany

来源：

AMERICAN JOURNAL OF TRANSPLANTATION | 2016年 / 16卷 / 03期

关键词：

INFECTION; MTOR; GRAFT; VIREMIA; IMMUNOSUPPRESSION; PROPHYLAXIS; TACROLIMUS; GUIDELINES; RECIPIENTS; DEATH;

D O I：

10.1111/ajt.13649

中图分类号：

R61 [外科手术学];

学科分类号：

摘要：

In order to investigate the hypothesis that the mammalian target of rapamycin inhibitor everolimus (EVR) shows anticytomegalovirus (CMV) activity in pediatric patients, we analyzed the impact of EVR-based immunosuppressive therapy on CMV replication and disease in a large cohort (n = 301) of pediatric kidney allograft recipients. The EVR cohort (n = 59), who also received low-dose cyclosporin, was compared with a control cohort (n = 242), who was administered standard-dose cyclosporin or tacrolimus and an antimetabolite, mostly mycophenolate mofetil (91.7%). Multivariate analysis revealed an 83% lower risk of CMV replication in the EVR cohort than in the control cohort (p = 0.005). In CMV high-risk (donor+/recipient-) patients (n = 88), the EVR-based regimen was associated with a significantly lower rate of CMV disease (0% vs. 14.3%, p = 0.046) than the standard regimen. In patients who had received chemoprophylaxis with (val-)ganciclovir (n = 63), the CMV-free survival rates at 1 year and 3 years posttransplant (100%) were significantly (p = 0.015) higher in the EVR cohort (n = 15) than in the control cohort (n = 48; 1 year, 75.0%; 3 years, 63.3%). Our data suggest that in pediatric patients at high risk of CMV, an EVR-based immunosuppressive regimen is associated with a lower risk of CMV disease than a standard-dose calcineurin inhibitor-based regimen.

引用

页码：921 / 929

页数：9

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