Influence of everolimus-based immunosuppression on infections in heart transplant recipients

Aims: Infections are a major complication after heart transplantation (HTx). They are a common cause of morbidity and the leading cause of death in the first year post HTx. The incidence of serious infections involving hospitalization under everolimus-based immunosuppression, however, is not yet well characterized and represents the aim of this study. Methods: A retrospective chart review of 61 patients transplanted between 2008 to 2011 was performed. Patient follow-up ranged from 12 to 36 month. The cohort was divided into 2 groups: Group I: everolimus in combination with a calcineurin inhibitor (CNI) or mycophenolat mofetil (MMF) and steroids vs. Group II: standard immunosuppression with a combination of CNI, MMF and steroids. Group I comprised of 41 patients, Group II of 20 patients. Only infections requiring hospitalization were considered, and classified as bacterial, viral, or fungal. Results: There was no significant difference in the overall rates of infections between Group I and Group II. Infectious episodes requiring hospitalization occurred in 42 patients, 27/41 [66%] in Group I and 15/20 [75%] in Group II (p = 0.469). Bacterial infections occurred in 21/41 [51%] of Group I and 13/20 [65%] of Group II (p = 0.309). There were no deaths in Group I, but two recipients of Group II died within the first year post HTx from serious infection with multi organ failure. Conclusion: This retrospective study did not reveal any differences in the rates of serious infections between the everolimus-based immunosuppression and the standard regimen. Thus, everolimus-based immunosuppression did not appear to carry a higher risk for infections, compared to standard therapy. Especially the incidence of bacterial infections was not in creased in our cohort.