Does the calcineurin inhibitor have influence on cytomegalovirus infection in heart transplantation?

Abstract

Cytomegalovirus (CMV) infection is a major cause of morbidity and mortality in heart transplant (HTx). Our aim was to analyze the rate of CMV infection in HTx patients receiving treatment with cyclosporine (CsA) or tacrolimus (Tac). Ninety-five patients were randomized to receive either CsA (53.7%) or Tac (46.3%). We performed prophylaxis with valganciclovir in patients with the highest risk of CMV infection. We considered CMV infection as an increased viral load or the presence of CMV in histological samples. We analyzed baseline characteristics, CMV infection, and other complications. Event-free rates were calculated using the Kaplan-Meier method. There were no significant differences in baseline characteristics between both groups. CMV infection was detected in 31.6% of patients (in 66.7% due to asymptomatic replication). The group treated with Tac had a lower rate of CMV infection (15.9% vs. 45.1%, p = 0.002) and longer CMV infection-free survival time (1440 vs. 899 d, p = 0.001). No differences were observed in the complications analyzed in both groups. The independent risk factors for infection identified in the multivariate analysis were treatment with CsA and bacterial infections. This was the first study to demonstrate a lower rate of CMV infection in patients treated with Tac vs. those treated with CsA after HTx.

Incidence of cytomegalovirus in cardiac transplant recipients receiving induction immunosuppression with antithymocyte globulin

“…Variations in maintenance immunosuppression regimens could have also contributed to differing rates of CMV as we had greater utilization of tacrolimus over cyclosporine. Of note, prior literature has reported significantly lower rates of CMV infection and longer CMV infection‐free survival time with tacrolimus over cyclosporine …”

Cytomegalovirus myocarditis in solid organ transplant recipients: A case series and review of literature

“…Like induction immunosuppression, maintenance immunosuppressive regimens have also been associated with the risk of CMV infection and disease. Most of our literature cases report a maintenance immunosuppression regimen of cyclosporine, azathioprine, and steroids; cyclosporine may be associated with higher rates of CMV infection when compared to tacrolimus, another calcineurin inhibitor, including in heart transplant recipients 23,24 . In our patients, one was on a regimen of tacrolimus, MMF, and prednisone and the other a regimen of belatacept, MMF, and prednisone.…”

The MANDELA study: A multicenter, randomized, open-label, parallel group trial to refine the use of everolimus after heart transplantation

“…CMV infection occurs in up to 30% of heart transplant recipients, even in the era of modern prophylaxis regimens, 18,19 In addition to the well-established manifestations of CMV syndrome and potentially organ-invasive CMV disease, CMV infection increases the risk of acute rejection 20 and is associated with accelerated development of CAV 21…”