Purpose: Single center evaluation of ganciclovir-resistant cytomegalovirus (GR-CMV) incidence, treatment and outcomes.

Methods: Review of adult abdominal transplant (aSOT) recipients from 1/1/1995-12/31/2015 with documented GR-CMV infection.

Results: Fifteen patients had documented GR-CMV (Table 1). Mutations of viral phosphotransferase (UL97) were present in 100% of patients; DNA polymerase (UL54) in an additional 40%. GR_CMV occurred ≤1 year post-transplant in 73% of cases. All patients received <900 mg daily of valganciclovir (VGC) prophylaxis prior to GR-CMV. Initial treatment for GR-CMV included a variety of regimens and combinations;100% reduced immunosuppression, 93% included foscarnet (FOS), 87% included IVIG. Average length of stay (LOS) for initial treatment was 20 days. Of patients with LOS <14 days discharged without GR-CMV treatment, 100% had detectable CMV PCR, and 83% were subsequently readmitted for treatment of GR-CMV within 2 months (60% in <20 days). No treatment regimen included leflunomide (LEF). Of those with LOS>14 days, 80% had CMV PCR <quantification, and only one patient was readmitted in <20 days. LEF was utilized in 83%. Following GR-CMV, rejection occurred in 50% of patients, graft loss in 27% and mortality in 20%. In patients with >3 admissions for GR-CMV related treatment, 100% had a major complication; rejection in 60%, graft loss in 20% and mortality rate in 40%

Conclusions: Incidence of GR-CMV is increasing at our center. Unifying demographics include D+/R-, lymphocyte-depletion, and VGC doses <900 mg. Outcomes are poor. R-ADM may be decreased when CMV is treated to negativity with an initial treatment regimen of decreased IS, FOS, IVIG and LEF.

CITATION INFORMATION: Fose J, Jorgenson M, Rolling K, McCreary E, Mandelbrot D, Smith J. Ganciclovir Resistant Cytomegalovirus Infection in Abdominal Tansplant Recipients. Am J Transplant. 2017;17 (suppl 3).

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