A single-center experience with ganciclovir-resistant cytomegalovirus in lung transplant recipients: treatment and outcome.

Published

Journal Article

BACKGROUND: Cytomegalovirus (CMV) disease is a major cause of morbidity and mortality after lung transplantation despite ganciclovir prophylaxis. The emergence of ganciclovir-resistant CMV in lung transplant patients has been reported, although the optimal strategy for the management of these infections remains uncertain. A review of the results of glanciclovir susceptibility testing in lung transplant recipients was performed. METHODS: We found 54% (113 of 210) of lung transplant patients developed CMV infection over a 4-year study period with ganciclovir-resistant CMV infection occurring in >5% of patients (6 of 113). The demographic and clinical characteristics of patients who developed ganciclovir-resistant vs -sensitive CMV infection were similar, although 50% (3 of 6) patients who developed resistance were CMV mismatched (D(+)/R(-) serology). All patients' CMV isolates had mutations in the UL97 gene. In addition, the 3 mismatch patients also had CMV with mutations in the UL54 gene. RESULTS: Treatment with a combination of foscarnet and ganciclovir or foscarnet alone for ganciclovir-resistant infection led to a significant reduction in virologic load in all patients (p = 0.03), although transient increases in viremia were observed in some patients early after treatment. Renal function worsened after treatment, but overall it was not significantly different from pre-treatment values (p = 0.07). CONCLUSIONS: Single or combination therapy with foscarnet is effective for treatment of ganciclovir-resistant isolates and excessive concern regarding toxicity should not preclude consideration of these treatments when clinically indicated.

Full Text

Duke Authors

Cited Authors

  • Reddy, AJ; Zaas, AK; Hanson, KE; Palmer, SM

Published Date

  • December 2007

Published In

Volume / Issue

  • 26 / 12

Start / End Page

  • 1286 - 1292

PubMed ID

  • 18096480

Pubmed Central ID

  • 18096480

Electronic International Standard Serial Number (EISSN)

  • 1557-3117

Digital Object Identifier (DOI)

  • 10.1016/j.healun.2007.09.012

Language

  • eng

Conference Location

  • United States