A Retrospective Review of Calcineurin Inhibitors’ Impact on Cytomegalovirus Infections in Lung Transplant Recipients

Rita Nogueiras-Álvarez,José Cifrián Martínez,María García Sáiz,María De Cos Cossío,Víctor Mora-Cuesta

doi:10.3390/transplantology2040045

Rita Nogueiras-Álvarez, José Cifrián Martínez + Show 3 more

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https://doi.org/10.3390/transplantology2040045

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Abstract

Immunosuppressive therapy reduces the risk for allograft rejection but leaves recipients susceptible to infections. Cytomegalovirus (CMV) is one of the most frequent causes for infection after transplantation and increases the risk for allograft rejection. As lung transplant recipients (LTRs) need to be under immunosuppression for life, they are a vulnerable group. To determine the potential association between the development of CMV infection and the calcineurin inhibitor (CNI) blood levels within previous 90 days, a retrospective review of LTRs was performed. Data from recipients who underwent a lung transplantation (LTx) at our center from January 2011 to December 2018 were collected. The studied recipients, after case/control matching, included 128 CMV-infection cases. The median time from the transplant to the first positive CMV viral load was 291.5 days. In our study, more patients were treated with tacrolimus (91.9%) than with cyclosporine (8.1%). Drug blood levels at selected timepoints showed no statistically significant difference between cases and controls. However, we found that CMV infection was more frequent in the donor-seropositive/recipient-seronegative group, interstitial lung disease (ILD) recipients, LTRs who underwent basiliximab induction, cyclosporine treated recipients, and LTRs with lymphopenia (at the time of CMV infection and 90 days before). In this review of LTRs, no association between the CNI blood level and CMV infection was seen, although other immunity-related factors were found to be influencing, i.e., basiliximab induction, cyclosporine treatment, and lymphopenia.

Highlights

Lung transplantation (LTx) has become a well-established therapeutic option for patients with an end-stage pulmonary disease
In addition to chronic lung allograft dysfunction (CLAD) which is the main cause for morbidity and the leading cause of death for those lung transplant recipients (LTRs) who survive beyond the first year, infections are another important cause for morbidity and mortality, especially in the first year after transplantation, reaching percentages of around
We initially reviewed a total number of 339 LTRs

Summary

Introduction

Lung transplantation (LTx) has become a well-established therapeutic option for patients with an end-stage pulmonary disease. Patients who undergo an LTx need to be under immunosuppression therapy for life, but this treatment, which is needed to reduce the risk of allograft rejection, involves risks. In addition to chronic lung allograft dysfunction (CLAD) which is the main cause for morbidity and the leading cause of death for those lung transplant recipients (LTRs) who survive beyond the first year, infections are another important cause for morbidity and mortality, especially in the first year after transplantation, reaching percentages of around. 30% of the total identified causes of death at that time [1]. The most frequent infectious complication in LTRs is bacterial infections (43–63%) [2], followed by those caused by cytomegalovirus (CMV). The most frequent infectious complication in LTRs is bacterial infections (43–63%) [2], followed by those caused by cytomegalovirus (CMV). 4.0/).

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