Characteristics and Outcomes of Resistant Cytomegalovirus (CMV) Disease in Solid Organ Transplant (SOT) Patients

P. Chong, P. Deziel, R. Razonable

Mayo Clinic, Rocheste

Meeting: 2013 American Transplant Congress

Abstract number: A577

Topic:

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.

Table 1:

Table 1
Patient	Age/Sex/Transplant type	CMV disease/Initial CMV load^a/Mutation	Onset^b	Duration of (V)GCV exposure^c	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/A^d	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)

F, female; M, male; CMVIG, CMV immunoglobulin; GCV, ganciclovir; VGCV, valganciclovir; KT, kidney transplant; GI, gastrointestinal; PAK, pancreas after kidney transplant; LT, liver transplant; VL, viral load; NR, specific mutation not reported; IS, immunosuppression; MT, maintenance therapy. ^aCMV load in copies/milliliter of blood at diagnosis of CMV disease. ^bOnset of disease in days from time of last transplant. ^cDuration of VGCV exposure in days at the time when resistance was suspected. ^dN/A : Did not receive prophylaxis. FOS, foscarnet. CDV, cidofovir. Cre, creatinine

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 July 30, 2021.

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