Antiviral efficacy and tolerance of an everolimus and low-dose tacrolimus immunosuppressive regimen after kidney transplantation ; Efficacité antivirale et tolérance d’un régime d’immunosuppression à base d’everolimus et tacrolimus faible dose en transplantation rénale

Background: The choice of the immunosuppressive regimen allows an optimized management of infectious complications after kidney transplantation (KT). Everolimus (EVR) has been associated with decreased incidences of cytomegalovirus (CMV) and BK virus (BKV) infections after KT. Materials and methods: 62 de novo kidney-transplant recipients (KTR) were included to receive EVR and low-dose tacrolimus (TAC) after an induction therapy of antithymoglobulins. Only CMV D+/R- patients (seronegative recipients of a seropositive donor) received antiviral prophylaxis. Results: The 18-month CMV infection incidence was 20.3%. CMV disease incidence tended to be lower in R+ (seropositive recipients) than in D+/R- patients (2.6% vs. 25.0%, respectively, p=0.063). 23.7% of R+ patients experienced an early CMV replication (median: 32 days), with a low viral load, often asymptomatic (88.9%) and spontaneously resolutive. In D+/R- patients, CMV infection was delayed (median: 329 days), associated with a high viral load, always symptomatic, requiring antiviral therapy and occurring after EVR discontinuation in most cases. Seven and two patients had BKV urinary and plasmatic viral replications, respectively. One year after KT, median eGFR was 50.6 mL/min with one single case of acute rejection. 69.5% of patients experienced adverse events leading to EVR discontinuation in 23.7%. Conclusion: EVR with low-dose TAC is associated with low CMV and BKV infections incidence in de novo KTR, especially in R+ patients who do not receive antiviral prophylaxis. ; Contexte : Le choix de l’immunosuppression en transplantation rénale permet d’optimiser les complications notamment infectieuses. L’everolimus (EVR) est associé à une moindre incidence des infections par le cytomégalovirus (CMV) et le BK virus (BKV) après transplantation rénale. Patients et méthodes : 62 patients greffés rénaux de novo ont été inclus pour recevoir EVR et tacrolimus (TAC) à faible dose après induction par antithymoglobulines. Seuls les patients D+/R- (receveur séronégatif ...