The influence of <scp>mTOR</scp> inhibitors on the incidence of <scp>CMV</scp> infection in high‐risk donor positive–recipient negative (D+/R−) kidney transplant recipients

Abstract

Abstract Introduction Several studies and meta‐analysis suggest the mTOR inhibitors are associated with reduced incidence of CMV infection after kidney transplantation, although their effects on the high‐risk population have not been investigated thoroughly. Objective This retrospective cohort study investigates the association between immunosuppression and CMV infection in D+/R− kidney transplant recipients receiving preemptive therapy. Methods All patients received rabbit anti‐thymocyte globulin, tacrolimus, prednisone and azathioprine ( AZA ), mycophenolate ( MPA ) or everolimus ( EVR ). Results Among 89 D+R−, the overall incidence of CMV infection was 76%, with no difference among the groups AZA vs MPA vs EVR (73 vs 83 vs 74%, P = 0.643). CMV infection occurred later (31 in AZA vs 31 in MPA vs 43 days in EVR group, P &lt; 0.001) and showed a lower trend of recurrences (57% in AZA vs 79% in MPA vs 48% in EVR group, P = 0.058) in the everolimus group. There were no differences in the IgG seroconversion rate (82% in AZA vs 76% in MPA vs 72% in EVR group, P = 0.983). There were no differences in the incidence of biopsy‐proven acute rejection (10% in AZA vs 8% in MPA vs 6% in EVR group, P = 0.811) and renal function at 12 months (53.6 in AZA vs 60.3 in MPA vs. 55.4 mL/min/1.73 m 2 in EVR group). Conclusion In this cohort of high‐risk CMV D+/R− kidney transplant recipients receiving rATG induction and tacrolimus, the use of mTOR inhibitors could only show a tendency towards but not a significant difference on the incidence of CMV events, when compared to antimetabolites.