Reduced-Dose Cidofovir (CID) and CMV-Hyperimmune Globulin (CMVIg) for Ganciclovir-Resistant Cytomegalovirus: Effective and Kidney Friendly.

S. Patel, S. Kuten, J. Snyder, R. Knight, A. Gaber.

Houston Methodist Hospital, Houston, TX.

Meeting: 2016 American Transplant Congress

Abstract number: C283

Keywords: Cytomeglovirus, Ganciclovir, Kidney, Viral therapy

Session Information

Session Name: Poster Session C: Viruses and SOT

Session Type: Poster Session

Date: Monday, June 13, 2016

Session Time: 6:00pm-7:00pm

Presentation Time: 6:00pm-7:00pm

Location: Halls C&D

Ganciclovir resistant (GR) CMV is associated with an aggressive disease course and substantial morbidity. Furthermore, treatment options such as foscarnet and cidofovir are incredibly nephrotoxic. The purpose of this study was to review our experience in treating 8 consecutive kidney transplant recipients with GR CMV disease with reduced-dose CID and CMV-Ig. All were high serologic risk (donor+/recipient-) and developed breakthrough viremia during low dose (450 mg/day) valganciclovir (VGC) prophylaxis at 105±30 days post-transplant. Mean age was 44±14 years, 4 (50%) were AA, 7 (88%) male, and 6 (75%) were deceased donor recipients. Following viremia detection, VGC was increased to 900 mg twice daily (renally adjusted). Genotype testing was performed upon failure to eradicate viremia. All patients exhibited UL97 mutations associated with ganciclovir resistance only. Upon diagnosis of GR CMV, tacrolimus was lowered to 4-6 ng/mL and mycophenolate to 1 g/day. CID with hydration and probenecid was given at 2 week intervals. CMVIg was given as adjunct therapy, and for potential immunomodulatory effects. An average of 6±2 CID dosages were given at a mean dose of 2.2±1.3 mg/kg. CMVIg 100 mg/kg was given 4±2 times. Viral clearance was achieved in all patients at a mean of 78±36 days. Mean GFRs at diagnosis and clearance were 69±26 and 69±21 ml/min/1.73², respectively. No patients experienced rejection, and one patient developed a single, transient low-level DSA. After a mean follow-up of 15 months, all patients are alive with functioning grafts. Reduced-dose CID and CMVIg offers an effective approach to treatment of GR CMV while preserving renal function and suppressing allo-reactivity in the setting of reduced immunosuppression and indirect viral effects.

Table 1. Patient and Treatment Summary
Patient	Max PCR	# CID dosages	Average CID dose, mg/kg	#CMVIg doses	Time to (-) PCR, days	GFR at diagnosis, ml/kg/1.73²	GFR at clearance, ml/kg/1.73²
1. 28 AA M	42807	7	1.05	7	115	54	45
2. 39 W M	2257	2	0.95	2	14	39	45
3. 32 AA M	6240	5	1.12	5	56	61	61
4. 32 AA M	2671	8	0.98	6	105	61	60
5. 62 AA F	170550	9	3.8	2	89	123	88
6. 60 H M	45237	6	2.84	3	110	62	68
7. 42 H M	148111	6	3.35	1	92	93	106
8. 59 W M	59752	6	3.49	4	46	62	76
AA, African American; F, female; H, Hispanic; M, male; W, White

CITATION INFORMATION: Patel S, Kuten S, Snyder J, Knight R, Gaber A. Reduced-Dose Cidofovir (CID) and CMV-Hyperimmune Globulin (CMVIg) for Ganciclovir-Resistant Cytomegalovirus: Effective and Kidney Friendly. Am J Transplant. 2016;16 (suppl 3).

To cite this abstract in AMA style:

Patel S, Kuten S, Snyder J, Knight R, Gaber A. Reduced-Dose Cidofovir (CID) and CMV-Hyperimmune Globulin (CMVIg) for Ganciclovir-Resistant Cytomegalovirus: Effective and Kidney Friendly. [abstract]. Am J Transplant. 2016; 16 (suppl 3). https://atcmeetingabstracts.com/abstract/reduced-dose-cidofovir-cid-and-cmv-hyperimmune-globulin-cmvig-for-ganciclovir-resistant-cytomegalovirus-effective-and-kidney-friendly/. Accessed May 11, 2025.

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