title: High incidence of ganciclovir-resistant cytomegalovirus infection among lung transplant recipients receiving preemptive therapy.
abstract: Preemptive antiviral therapy in transplant patients is thought to be less likely to lead to antiviral resistance than is routine prophylaxis. Cytomegalovirus (CMV)-seropositive lung transplant patients (R+) were assigned to receive pp65 antigen-guided ganciclovir therapy, and seronegative recipients of organs from seropositive donors (D+/R-) were assigned to receive initially preemptive and then routine ganciclovir prophylaxis. The incidence of infection with ganciclovir-resistant (ganR) CMV was assessed retrospectively. GanR CMV infection developed in 4 (9%) of 45 patients, at a median of 4.4 months (range, 3.1-6.6 months) after transplantation, and was more common among D+/R- patients than among R+ patients (3 of 11 vs. 1 of 34; P =.04). The incidence among patients who received preemptive therapy was similar to that among patients who received routine prophylaxis. All ganR isolates contained a UL97 mutation. GanR CMV infection occurs in nearly 10% of lung transplant recipients, despite preemptive antiviral therapy, and is more common among D+/R- patients.
authors.affiliation: Department of Laboratory Medicine, University of Washington, Seattle, WA, USA. limaye@u.washington.edu
authors.forename: Ajit P
authors.initials: AP
authors.lastname: Limaye
authors.forename: Ganesh
authors.initials: G
authors.lastname: Raghu
authors.forename: David M
authors.initials: DM
authors.lastname: Koelle
authors.forename: James
authors.initials: J
authors.lastname: Ferrenberg
authors.forename: Meei-Li
authors.initials: ML
authors.lastname: Huang
authors.forename: Michael
authors.initials: M
authors.lastname: Boeckh
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D019072:Antibiotic Prophylaxis / Q000009:adverse effects*; D000998:Antiviral Agents / Q000627:therapeutic use*; D003587:Cytomegalovirus / Q000187:drug effects*; D003586:Cytomegalovirus Infections / Q000453:epidemiology / Q000517:prevention & control*; D024882:Drug Resistance, Viral; D004751:Enteritis / Q000453:epidemiology; D005260:Female; D015774:Ganciclovir / Q000627:therapeutic use*; D006801:Humans; D016040:Lung Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D011014:Pneumonia / Q000453:epidemiology; D014775:Virus Activation
chemical_list: D000998:Antiviral Agents; D015774:Ganciclovir