AIM: Immunosuppression with an mTOR inhibitor plus calcineurin inhibitor (CNI) minimization is increasingly used in liver transplantation to protect against the nephrotoxic and neurotoxic side effects associated with CNI's. However, mTOR inhibitors have been linked to infectious complications. The aim of this study was to examine the incidence and risk factors for infection after liver transplantation in patients treated with everolimus. METHODS: This is a single center retrospective review of infectious complications in 82 patients transplanted from 5/2012-10/2012, of whom 53 were converted from mycophenolate to everolimus and low-dose tacrolimus, and 29 were maintained on either tacrolimus alone, tacrolimus + mycophenolate, or cyclosporine. Infections included in the analysis include anything requiring antibiotics or hospital re-admission. Complications related to impaired wound healing were excluded. RESULTS: The mean time from transplant to conversion to everolimus was 139±122 days. The baseline characteristics between the patients who were and were not converted to everolimus did not differ between the two groups. 53 of the 82 (65%) recipients experienced post-transplant infections, including 25 recipients with >1 infection episode (range 2-6 episodes). Mean MELD in patients who did and did not develop infection was 28.8 and 27.6, respectively (p=0.597). A total of 117 infections were identified; the median time between transplant and infection was 112 days (IQR 46-267 days). The most common infection type was bacteremia (n=24, 21%), followed by urinary tract infections (n=20, 17%), pneumonia (n=19, 16%), and colitis (n=14, 12%). 48 (41%) of the infections occurred after everolimus conversion (mean 150±134 days post conversion). Recipients converted to everolimus were not associated with increased odds for infections (OR=0.74, p=0.55), and among recipients who developed infections, those with more than one infection episode were not significantly associated with everolimus conversion (OR=1.6, p=0.42). CONCLUSION: Conversion from CNI's to an mTOR inhibitor is a safe alternative and is not associated with a higher incidence of infection.
|Original language||English (US)|
|Journal||American Journal of Transplantation|
|Issue number||15 (suppl 3)|
|State||Published - May 2 2015|