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Successful conversion to everolimus after cytomegalovirus infection in a heart transplant recipient

Teruhiko Imamura1, Taro Shiga, Koichiro Kinugawa

  • 1Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo, Japan.

International Heart Journal
|July 14, 2012
PubMed

Insights

Cytomegalovirus infection is a risk after heart transplants. Everolimus (EVL) may prevent cytomegalovirus (CMV) reactivation and neutropenia, offering a safer alternative to valganciclovir (VGC) and mycophenolate mofetil (MMF).

Area of Science:

  • Immunology
  • Transplantation Medicine
  • Infectious Diseases

Background:

  • Cytomegalovirus (CMV) infection is a significant threat in heart transplant recipients, contributing to cardiac allograft vasculopathy and mortality.
  • Valganciclovir (VGC), a common treatment for CMV, is frequently associated with neutropenia, particularly when co-administered with mycophenolate mofetil (MMF).

Observation:

  • A heart transplant recipient experiencing CMV antigenemia and progressive neutropenia while on VGC and MMF.
  • Switching mycophenolate mofetil (MMF) to everolimus (EVL) resulted in sustained negative CMV antigenemia assays, even after VGC discontinuation.
  • In a cohort of 14 heart transplant recipients, everolimus (EVL) administration was associated with consistently negative CMV antigenemia assays.

Findings:

  • Everolimus (EVL) demonstrated a potential prophylactic effect against cytomegalovirus (CMV) reactivation in heart transplant recipients.
  • The switch from MMF to EVL successfully managed CMV antigenemia and resolved neutropenia in the observed case.
  • Everolimus (EVL) appears to be a viable alternative for managing or preventing CMV infection and associated complications in heart transplant patients.

Implications:

  • Everolimus (EVL) may serve as a crucial alternative immunosuppressant to mitigate CMV-related complications and neutropenia in heart transplant recipients.
  • Early consideration of everolimus (EVL) in CMV-seronegative heart transplant recipients could be beneficial for prophylaxis.
  • This finding suggests a potential shift in immunosuppressive strategies to improve outcomes in heart transplantation.

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