Cytomegalovirus disease in de novo kidney-transplant recipients: comparison of everolimus-based immunosuppression withou
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NEPHROLOGY - ORIGINAL PAPER
Cytomegalovirus disease in de novo kidney‑transplant recipients: comparison of everolimus‑based immunosuppression without prophylaxis with mycophenolic acid‑based immunosuppression with prophylaxis Louis Manière1 · Johan Noble1 · Florian Terrec1 · Hamza Naciri Bennani1 · Eloi Chevallier1 · Bénédicte Janbon1 · Raphaele Germi2 · Mathilde Bugnazet1 · Farida Imerzoukene1 · Paolo Malvezzi1 · Lionel Rostaing1,3 · Thomas Jouve1,3 Received: 10 April 2020 / Accepted: 3 October 2020 © Springer Nature B.V. 2020
Abstract Purpose To compare everolimus (EVR) plus low-dose tacrolimus (TAC) with mycophenolic acid (MPA) plus standard-dose TAC with regards to rates of cytomegalovirus (CMV) disease in de novo kidney-transplant recipients (KTRs). Methods This single-center retrospective study included 187 de novo KTRs; 59 patients (31.6%) received EVR/low-dose TAC (group 1); 128 patients (68.4%) received MPA with standard-dose TAC (group 2). All received anti-thymocyte globulins as the induction therapy, and steroid-sparing strategy. Valganciclovir prophylaxis was mandatory for CMV D+/R− KTRs (seronegative recipients of a seropositive donor) in both groups and for R+ seropositive recipients (only in group 2). Results The 2-year incidence of CMV disease was low and comparable between groups: 6.8% and 7.0% in groups 1 and 2, respectively (p = 0.94). There was no statistical difference in CMV serostatus (p = 1). However, CMV disease tended to be less frequent, though not statistically different, in R+ KTRs receiving EVR without prophylaxis (3.7% vs. 8.5% in groups 1 and 2, respectively) and in patients without EVR discontinuation (2.6% vs. 6.9% in patients who did not discontinue MPA (p = 0.29). Two-year graft function was good and comparable between groups (median eGFR of 54.2 and 53.0 mL/min in groups 1 and 2, respectively; p = 0.47); incidence of immunological events was low. Significantly more patients in group 1 discontinued EVR because of adverse events than patients that discontinued MPA in group 2 (35.6% in group 1 vs. 10.2% in group 2; p 4 log copies/mL
International Urology and Nephrology
• In group 2, prophylaxis, i.e., valganciclovir 900 mg/day
Statistical analyses
CMV infection management
Categorical variables are reported as frequencies and percentages. Continuous variables are presented as medians with interquartile ranges (IQR) or extreme ranges. Classical Wilcoxon and Chi-squared tests were used to compare medians and proportions, respectively. Kaplan–Meier curves were produced, and the log-rank test was used to assess survival differences between groups 1 and 2. A multivariate survival analysis using a Cox model was performed to assess the effect of potential confounders. This model was built on the covariates showing a significant univariate association (p
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