CMV and BK Virus Infections in Kidney Transplant Recipients Receiving an mTORi-Based Regimen versus a CNI-Based Regimen: A Systematic Review and Meta-Analysis.
1Division of Nephrology, American University of Beirut Medical Center, Beirut, Lebanon
2Renal Division, Harvard Medical School, Boston
Meeting: 2017 American Transplant Congress
Abstract number: D115
Keywords: Cytomeglovirus, Immunosuppression, Meta-analysis, Polyma virus
Session Information
Session Name: Poster Session D: Kidney Immunosuppression: Novel Regimens and Drug Minimization
Session Type: Poster Session
Date: Tuesday, May 2, 2017
Session Time: 6:00pm-7:00pm
Presentation Time: 6:00pm-7:00pm
Location: Hall D1
The objective of this systematic review is to compare the incidence of CMV and BK virus infections in kidney transplant recipients receiving an mTORi-based as compared to a CNI-based regimen.
Methods:We underwent a comprehensive search of literature for RCTs addressing our objective.
Results:We included 33 trials,with 7277 participants,classified in 3 comparisons.Meta-analysis showed a significant reduction of CMV in mTORi groups.
There was a trend towards decreased BK with mTORi.
Meta-analysis for acute rejection showed an increased risk with mTORi in comparison 1 and a similar rate for comparisons 2 and 3.Estimated GFR favored the mTORi group in comparisons 1 and 2, and the CNI-based regimen in comparison 3.
| Comparison | Outcome | Conclusion | Nb of RCTs |
| 1 | acute rejection | increased risk in mTORi(RR 1.35, 95%CI 1.07-1.7) | 19 RCTs, N=3921 |
| eGFR | higher in mTORi(MD 4.07, 95% CI 1.34-6.8) | 18 RCTs, N=3768 | |
| 2 | acute rejection | no difference(RR 0.88, 95% CI 0.7-1.09) | 5 RCTS, N=1553 |
| eGFR | trend towards higher eGFR in mTORi(MD 3.36, 95% CI -4.31,11.02) | 5 RCTs, N=1543 | |
| 3 | acute rejection | trend towards decreased risk in mTORi(RR 0.82, 95% CI 0.64-1.04) | 5 RCTs, N=1128 |
| eGFR | lower in mTORi(MD -5.68, 95% CI -8.64, -2.72) | 3 RCTs, N=539 |
Conclusions: We demonstrated around 50% reduction of CMV infection in mTORi-based regimen. No definite conclusion was possible for BK.Our review suggested that a combination of an mTORi and a reduced dose CNI may offer similar rates of acute rejection, and improved GFR,when compared to a standard CNI-based regimen.
CITATION INFORMATION: Tanios B, Mallat S, Itani H, Lotfi T, Gabardi S, Akl E, Azzi J. CMV and BK Virus Infections in Kidney Transplant Recipients Receiving an mTORi-Based Regimen versus a CNI-Based Regimen: A Systematic Review and Meta-Analysis. Am J Transplant. 2017;17 (suppl 3).
To cite this abstract in AMA style:
Tanios B, Mallat S, Itani H, Lotfi T, Gabardi S, Akl E, Azzi J. CMV and BK Virus Infections in Kidney Transplant Recipients Receiving an mTORi-Based Regimen versus a CNI-Based Regimen: A Systematic Review and Meta-Analysis. [abstract]. Am J Transplant. 2017; 17 (suppl 3). https://atcmeetingabstracts.com/abstract/cmv-and-bk-virus-infections-in-kidney-transplant-recipients-receiving-an-mtori-based-regimen-versus-a-cni-based-regimen-a-systematic-review-and-meta-analysis/. Accessed November 25, 2024.« Back to 2017 American Transplant Congress