Cytomegalovirus (CMV) remains a major cause of morbidity and mortality in lung transplant recipients (LTR) and the emergence of resistant CMV (rCMV) has increased. The purpose of this study is to characterize rCMV in LTR.

This is an IRB-approved, single-center retrospective study of LTR transplanted between 1/2010-12/2014 who developed rCMV. Patients receiving multi-organ transplants and re-transplants were excluded.

299 patients received a lung transplant during the study period. 16 (5%) developed rCMV. Baseline characteristics and outcomes are below.

All patients with rCMV were D+/R- and 94% received ganciclovir prophylaxis. 75% were transplanted in 2011-2013 and 82% developed rCMV in 2012-2014. Median time to develop rCMV was 378 days (IQR 227, 628). 50% were on CMV prophylaxis at the time of the first positive CMV PCR. Mortality was 25% and no trend was observed in the FEV₁ change 6 months prior to and 6 months after rCMV. 38% had a change in CMV genotype, but all had resistance to ganciclovir at UL97. 94% were treated with combination antiviral therapy and foscarnet was most commonly used.

There is an apparent increase in the incidence of rCMV over time. All patients were at high risk (D+/R-) for developing CMV and most required combination therapy with toxic antivirals. There was no trend in the change of FEV₁ before and after rCMV. Additional study is warranted to confirm these findings and identify causes to further characterize the impact of rCMV on LTR.

CITATION INFORMATION: Hammad S, Shah L, Restivo M, Robbins H, Scheffert J. Characterization of Resistant Cytomegalovirus in Lung Transplant Recipients in the Modern Era. Am J Transplant. 2016;16 (suppl 3).

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