RELATIONSHIP BETWEEN IMMUNOSUPPRESSION AND SUBSEQUENT DEVELOPMENT OF CMV DISEASE

Abstract

P375 Aims: CMV disease has a significant influence on early and late transplant outcomes. Treatment is costly and associated with side effects, including bone marrow toxicity and nephrotoxicity. The purpose of this study was to identify immunosuppressive regimens with adequate efficacy and associated with lower incidence of CMV disease. Methods: Between 24/06/1998 and 16/08/2003 525 patients were included in prospective clinical trials using different drug combinations (Table 1). IL-2R monoclonal antibodies were used in 20% of patients. CMV disease was diagnosed as a positive antigenemia, clinical symptoms, laboratorial findings associated with CMV infection or tissue analysis. All patients were treated with ganciclovir for 14 to 42 days. Demographic data, biopsy-confirmed acute rejection, and treatment of acute rejection were recorded.FigureResults: Mean age was 37±12 years, 63% males, 50% white. 90% were recipients of living and 10% of cadaveric allografts. Overall incidence of biopsy-confirmed acute rejection was 27% and 1% of them required treatment with antibody. Mean time to acute rejection was 86±199 days. Five-year patient and graft survivals were 96.7% and 89.9%, respectively. Among 506 patients with available pretransplant CMV donor (D) and recipient (R) serologic status (IgG) there were 3% D(-)R(-), 5% D(-)R(+), 11% D(+)R(-) and 81% D(+)R(+). Thirty (5,7%) patients [43% R(-), 57% R(+)] developed CMV infection (21 syndromes; 4 tissue invasive and 5 clinically diagnosed) at a mean time of 109±128 days after transplantation. There were 3 relapses successfully treated with another course of ganciclovir. Among patients who showed CMV infection, 19 (63%) had biopsy-confirmed acute rejection (20% required antibody treatment), 47% was using MMF (6 with CSA, 1 with TAC, 5 with SRL and 2 with prednisone only). Graft loss was more frequent among patients who developed CMV infection (17% vs. 7%). Conclusions: CMV infection was associated with the use of MMF and with higher incidence of graft loss. Table 1. Immunosuppressive regimens CsA: cyclosporine; TAC: tacrolimus; AZA: azathioprine; MMF: mycophenolate mofetil; SRL; sirolimus; EVL: everolimus; FTY: FTY720; PRED: prednisone