Effects of changing immunosuppressive regimen on the incidence, duration, and viral load of cytomegalovirus infection in renal transplantation: a single center report

Abstract

Background. In this retrospective single center study we have evaluated the relation between the immunosuppressive regimen and the incidence and characteristics of cytomegalovirus (CMV) infection in the setting without CMV prophylaxis from 1989 through 1998. Methods. All (470) first cadaveric renal transplantations in nonsensitized (PRA < 60%) patients were analyzed. Immunosuppression consisted of cyclosporine A (Sandimmune) and prednisolone from 1989 through 2-1993 (S; 189 patients), of cyclosporine microemulsion (Neoral) and prednisolone from 3-1993 through 5-1997 (N; 200 patients) and of mycophenolate mofetil, Neoral and prednisolone from 5-1997 until 1998 (M; 81 patients). The CMV pp65-antigenemia was measured routinely at least once weekly from day 10 till 12 weeks after transplantation or until pp65-antigenemia became negative. No CMV-prophylaxis was given. Results. By changing from Sandimmune to Neoral and by adding mycophenolate mofetil, respectively, we observed a higher frequency of especially secondary CMV infections (S vs. N vs. M, respectively, 28 vs. 50 vs. 63%, P = 0.026; S vs. N, P = 0.027; S vs. M, P = 0.015; and N vs. M, n.s). The CMV infections lasted longer (median duration antigenemia S vs. N vs. M, respectively, 3 vs. 5 vs. 7 weeks, P = 0.0003; S vs. N, P < 0.002; S vs. M, P < 0.001; and N vs. M, P < 0.05). Viral load was higher in M (median maximal pp65-antigenemia S vs. N vs. M, respectively, 19 vs. 14.5 vs. 73, P < 0.01; S vs. N, n.s.; S vs. M, P < 0.001 and N vs. M, P < 0.01). Conclusions. The use of Neoral and the addition of mycophenolate mofetil caused significant changes in the incidence, duration and viral load of CMV infections.

Six-Month Prophylaxis Is Cost Effective in Transplant Patients at High Risk for Cytomegalovirus Infection

“…4,33,34 Our findings clearly showed that the use of T cell-depleting antibodies such as Thymoglobulin increased the risk for CMV infection and disease compared with IL-2 receptor antagonists in CMV Dϩ/RϪ patients. In addition, our study suggests that the choice of CNIs CLINICAL RESEARCH www.jasn.org may influence the risk of CMV disease in this group of patients.…”

Impact of Immunosuppressive Treatment on Endothelial Biomarkers After Kidney Transplantation

“…During CMV infection, endothelial cells acquire a cytomegalic morphology (36) and can be detached from the vessel wall (36)(37)(38). Moreover, CMV infection increases the risk of coronary disease and of death in transplanted patients (39) and is linked to chronic transplant dysfunction (40 (48,49) that are reflected by higher CEC (50) and EMP levels (51). In addition, EMP (52) …”

Does mycophenolate mofetil increase the risk of cytomegalovirus infection in solid organ transplant recipients?: A mini-review

“…In a study by de Maar et al [6], 470 renal transplant recipients were retrospectively evaluated according to the immunosuppressive regimen used: cyclosporine (standard formulation) and prednisolone, versus cyclosporine (microemulsion formulation) and prednisolone, versus MMF and cyclosporine and prednisolone. Patients who received induction therapy with OKT3 or ATG were excluded, and gancyclovir was given preemptively.…”

“…Additionally, CMV has been found to be an independent risk factor for the development of other infectious complications, such as bacteremias, invasive fungal diseases and Epstein Barr virus (EBV)-related post-transplant lymphoproliferative disease; it is also a cause of acute and chronic allograft injury [5]. There is a hypothesis that cytomegalovirus may cause endothelial damage in the transplanted organ, leading to chronic transplant dysfunction [6].…”