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

Int Heart J. 2012;53(3):199-201. doi: 10.1536/ihj.53.199.

Abstract

Cytomegalovirus (CMV) infection remains a major problem in recipients with heart transplantation (HTx), because it may play a significant role in the development of cardiac allograft vasculopathy, which is one of the major causes of death after HTx. Valganciclovir (VGC) is effective for the treatment of CMV infection, but is often associated with neutropenia, especially when used with mycophenolate mophetil (MMF). We experienced an HTx recipient with positive CMV antigenemia who suffered progressive neutropenia after administration of VGC. We switched MMF to everolimus (EVL) and assay for CMV antigenemia was constantly negative even after discontinuation of VGC. In all other 14 HTx recipients who received EVL for any reason, we found that assay for CMV antigenemia remained negative throughout the period of EVL administration. Considering the prophylactic effect on CMV, EVL can not only be an alternative to rescue from comorbidity, but might also be indicated earlier especially in CMV-seronegative HTx recipients.

Publication types

  • Case Reports

MeSH terms

  • Adult
  • Antigens, Viral / blood
  • Antiviral Agents / adverse effects*
  • Antiviral Agents / therapeutic use*
  • Cytomegalovirus / immunology
  • Cytomegalovirus Infections / drug therapy*
  • Cytomegalovirus Infections / virology
  • Drug Substitution*
  • Drug Therapy, Combination
  • Everolimus
  • Ganciclovir / adverse effects
  • Ganciclovir / analogs & derivatives*
  • Ganciclovir / therapeutic use
  • Heart Transplantation*
  • Heart-Assist Devices
  • Humans
  • Immunosuppressive Agents / adverse effects*
  • Immunosuppressive Agents / therapeutic use*
  • Male
  • Mycophenolic Acid / adverse effects
  • Mycophenolic Acid / analogs & derivatives*
  • Mycophenolic Acid / therapeutic use
  • Neutropenia / chemically induced*
  • Opportunistic Infections / drug therapy*
  • Opportunistic Infections / virology
  • Sirolimus / adverse effects
  • Sirolimus / analogs & derivatives*
  • Sirolimus / therapeutic use
  • Valganciclovir

Substances

  • Antigens, Viral
  • Antiviral Agents
  • Immunosuppressive Agents
  • Everolimus
  • Valganciclovir
  • Mycophenolic Acid
  • Ganciclovir
  • Sirolimus