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

Publication ,  Journal Article
Reddy, AJ; Zaas, AK; Hanson, KE; Palmer, SM
Published in: J Heart Lung Transplant
December 2007

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.

Duke Scholars

Published In

J Heart Lung Transplant

DOI

EISSN

1557-3117

Publication Date

December 2007

Volume

26

Issue

12

Start / End Page

1286 / 1292

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Surgery
  • Retrospective Studies
  • Postoperative Complications
  • Phosphotransferases (Alcohol Group Acceptor)
  • Opportunistic Infections
  • Mutation
  • Middle Aged
  • Male
  • Lung Transplantation
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Reddy, A. J., Zaas, A. K., Hanson, K. E., & Palmer, S. M. (2007). A single-center experience with ganciclovir-resistant cytomegalovirus in lung transplant recipients: treatment and outcome. J Heart Lung Transplant, 26(12), 1286–1292. https://doi.org/10.1016/j.healun.2007.09.012
Reddy, Anita J., Aimee K. Zaas, Kimberly E. Hanson, and Scott M. Palmer. “A single-center experience with ganciclovir-resistant cytomegalovirus in lung transplant recipients: treatment and outcome.J Heart Lung Transplant 26, no. 12 (December 2007): 1286–92. https://doi.org/10.1016/j.healun.2007.09.012.
Reddy AJ, Zaas AK, Hanson KE, Palmer SM. A single-center experience with ganciclovir-resistant cytomegalovirus in lung transplant recipients: treatment and outcome. J Heart Lung Transplant. 2007 Dec;26(12):1286–92.
Reddy, Anita J., et al. “A single-center experience with ganciclovir-resistant cytomegalovirus in lung transplant recipients: treatment and outcome.J Heart Lung Transplant, vol. 26, no. 12, Dec. 2007, pp. 1286–92. Pubmed, doi:10.1016/j.healun.2007.09.012.
Reddy AJ, Zaas AK, Hanson KE, Palmer SM. A single-center experience with ganciclovir-resistant cytomegalovirus in lung transplant recipients: treatment and outcome. J Heart Lung Transplant. 2007 Dec;26(12):1286–1292.
Journal cover image

Published In

J Heart Lung Transplant

DOI

EISSN

1557-3117

Publication Date

December 2007

Volume

26

Issue

12

Start / End Page

1286 / 1292

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Surgery
  • Retrospective Studies
  • Postoperative Complications
  • Phosphotransferases (Alcohol Group Acceptor)
  • Opportunistic Infections
  • Mutation
  • Middle Aged
  • Male
  • Lung Transplantation