Objective: We assessed the characteristics and outcomes of genotype-proven resistant CMV after SOT.
Methods : The SOT database was reviewed during 2001-2012 to identify patients with genotype-proven resistant CMV.
Results: Nine of 3444 (0.26%) patients developed genotype-proven resistant CMV, including 5 KT, 2 PAK, 1 LT and 1 lung. All were CMV D+/R-. Most (n=7) had tissue-invasive CMV disease. One patient died, and two had drug-induced graft loss. Most (n=8) had UL97, one had isolated UL54, and two developed UL54 mutations during treatment.
|Patient||Age/Sex/Transplant type||CMV disease/Initial CMV loada/Mutation||Onsetb||Duration of (V)GCV exposurec||Initial Therapy||Definitive Therapy||Outcome|
|1||64/F/KT||GI disease;474,000;UL97 (NR)||132||132||VGCV (6w)||FOS+CMVIG||Died;Graft loss (FOS)|
|2||59/M/KT||GI disease;101,000;UL97 (NR)||122||192||VGCV (4w) then MT||FOS+CMVIG||Alive;Interstitial nephritis (FOS)|
|3||54/M/PAK||CMV Syndrome;5211;UL54 (NR)||150||300||VGCV (16w)||CDV+CMVIG||Alive;Graft loss (FOS/CDV)|
|4||35/M/PAK||GI disease;263,000;UL97 (NR)||173||270||IV GCV (1w) then VGCV (7w) then MT||FOS||Alive;Pancreas rejection (IS reduction)|
|5||52/M/LT||GI disease;50,500;UL97 (A594V)||23||N/Ad||IV GCV (2w) then VGCV (2w) then MT||1.IV GCV 2.FOS 3.VGCV||Alive;Elev cre (FOS)|
|6||45/F/KT||GI disease;27,700;UL97 (C603W)||137||137||IV GCV (2w)+CMVIG||FOS+CMVIG||Alive;Rash (FOS)|
|7||57/M/KT||CMV Syndrome;3000;UL97 (A594V)||88||88||VGCV (7w) then MT (2w)||1.IV GCV 2.FOS||Alive;Elev cre (FOS)|
|8||65/M/KT||GI disease;5490;UL97 (L595S) then UL54(A987G/A)||358||93||IV GCV (6w) then MT||1.IV GCV+CMVIG 2.VGCV 3.High dose IV GCV+CMVIG 4.CMVIG||Alive|
|9||43/M/Lung Tx||Multiorgan;794,000;UL97 (C603W) the UL54(T503T/I)||332||332||IV GCV (1w)||1.FOS 2.CDV+CMVIG 3.FOS+CMVIG 4.Intravitreal FOS||Alive;Encephalopathy (FOS). Elev cre (CDV)|
Conclusions: Drug-resistant CMV is an uncommon but potentially fatal infection. Treatment-related graft loss is common. Resistance may develop during treatment.
To cite this abstract in AMA style:Chong P, Deziel P, Razonable R. Characteristics and Outcomes of Resistant Cytomegalovirus (CMV) Disease in Solid Organ Transplant (SOT) Patients [abstract]. Am J Transplant. 2013; 13 (suppl 5). https://atcmeetingabstracts.com/abstract/characteristics-and-outcomes-of-resistant-cytomegalovirus-cmv-disease-in-solid-organ-transplant-sot-patients/. Accessed April 19, 2021.
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