The effect of sirolimus-based immunosuppression vs. conventional prophylaxis therapy on cytomegalovirus infection after liver transplantation

Clin Transplant. 2015 Jun;29(6):555-9. doi: 10.1111/ctr.12552. Epub 2015 May 6.

Abstract

Objective: The aim of this study was to assess the efficacy of sirolimus-based immunosuppression vs. conventional prophylaxis therapy in preventing cytomegalovirus (CMV) infection or disease in liver transplantation recipients.

Methods: One hundred and twenty-seven consecutive liver transplant recipients, with a minimum of one-yr follow-up from 2008 to 2013 in the first affiliated hospital of Nanchang University, were retrospectively divided into the sirolimus-treated (n = 51) and ganciclovir-treated (n = 76) groups. The CMV incidence, rejection events, and survival rate were compared.

Results: The overall incidences of CMV events were decreased but did not reach statistical significance in the sirolimus arm compared with the ganciclovir arm (p > 0.05) at one yr after liver transplantation. There was no significant difference in the rejection incidence and survival rates between the two groups.

Conclusions: Sirolimus-based immunosuppression had a lower incidence of CMV infection compared with conventional prophylaxis therapy and did not increase rejection risks and mortality after liver transplantation, indicating that with the use of an mammalian target-of-rapamycin (mTOR)-inhibitor, CMV prophylaxis may be dispensable.

Keywords: cytomegalovirus; effect; liver transplantation; prophylaxis therapy; sirolimus.

Publication types

  • Comparative Study
  • Evaluation Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Antiviral Agents / therapeutic use*
  • Cytomegalovirus Infections / epidemiology
  • Cytomegalovirus Infections / etiology
  • Cytomegalovirus Infections / immunology
  • Cytomegalovirus Infections / prevention & control*
  • Female
  • Follow-Up Studies
  • Ganciclovir / therapeutic use*
  • Graft Rejection / prevention & control
  • Graft Survival
  • Humans
  • Immunocompromised Host
  • Immunosuppressive Agents / therapeutic use*
  • Incidence
  • Liver Transplantation* / mortality
  • Male
  • Middle Aged
  • Postoperative Complications / epidemiology
  • Postoperative Complications / immunology
  • Postoperative Complications / prevention & control*
  • Retrospective Studies
  • Sirolimus / therapeutic use*
  • Treatment Outcome

Substances

  • Antiviral Agents
  • Immunosuppressive Agents
  • Ganciclovir
  • Sirolimus