ATC Abstracts

American Transplant Congress abstracts

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

Mayo Clinic, Rocheste

Meeting: 2013 American Transplant Congress

Abstract number: A577

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 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)
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 April 19, 2021.

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