Purpose – Cytomegalovirus (CMV) infection is a major complication in heart transplant recipients. Recent trials indicate that the use of the mammalian target of rapamycin (mTOR) inhibitors, everolimus (EVL) was not only effective in preventing rejection but also impacts on the risk of CMV infection in other organ recipients. However, the appropriate timing when to administrate EVL is unknown. This study was to investigate when everolimus should be administrated to prevent CMV infection in heart transplant recipients.

Methods – We retrospectively evaluated 33 patients who were converted to EVL from mycophenolate mofetil after heart transplantation at Osaka University Hospital. All of them received prophylactic antiviral therapy with gancyclovir. CMV infection is defined as evidence of CMV antigenemia (C7-HRP>5 cells). “Recurrent infection” was defined as new detection of CMV infection in a patient who had had previously documented infection and who had not had virus detected for an interval of at least 4 weeks during active surveillance.

Results – The median time of the switch to EVL after transplantation was 432 (34-2214) days. Of the 33 patients, 11 patients received EVL after the evidence of CMV infection; Post-infection group, 22 patients received EVL before CMV infection; Pre-infection group. Thereafter, six patients had recurrent CMV infection in who received EVL after primary CMV infection and no patients had recurrent CMV infection in who received EVL before primary infection (post-infection group; 55% vs pre-infection group; 0% log-rank; p=0.0002).

Conclusions – Early administration EVL before evidence of CMV antigenemia may be a useful strategy to prevent recurrent of CMV infection.

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