The use of sirolimus in ganciclovir-resistant cytomegalovirus infections in renal transplant recipients.
BACKGROUND
The widespread use of prophylactic ganciclovir and anti-lymphocyte/thymocyte therapies are associated with increased induction of ganciclovir-resistant cytomegalovirus (CMV) strains. The use of sirolimus has been associated with a lower incidence of CMV infection in transplant recipients. We questioned whether it could also be effective as a therapeutic treatment of resistant CMV infection.


METHODS
Patients with ganciclovir-resistant CMV infections determined clinically and by DNA sequencing analysis were enrolled. Antigenaemia and DNA sequencing were used to diagnosis and follow the mutations.


RESULTS
Nine transplant patients were given sirolimus plus mycophenolate mofetil (n = 4) or a calcineurin inhibitor (n = 5). Seven out of nine recipients were CMV IgG negative before transplantation. We observed a rapid decrease in antigenaemia levels, reaching zero in eight out of nine (88.9%) patients within a median of 20.3 +/- 10.1 d. Graft function remained stable and no patient presented acute rejection or recurrence of the CMV infection.


CONCLUSIONS
This suggests that the use of sirolimus plus ganciclovir therapy could be useful in ganciclovir-resistant CMV infections.
Ozaki
Kikumi Suzete
KS
Laboratório de Imunologia Clínica e Experimental, Division of Nephrology, Universidade Federal de São Paulo, São Paulo, Brazil.
Câmara
Niels Olsen Saraiva
NO
Nogueira
Eliana
E
Pereira
Mauricio Galvão
MG
Granato
Celso
C
Melaragno
Cláudio
C
Camargo
Luis Fernando Aranha
LF
Pacheco-Silva
Alvaro
A
D000328:Adult; D000998:Antiviral Agents / Q000627:therapeutic use*; D003586:Cytomegalovirus Infections / Q000188:drug therapy*; D024882:Drug Resistance, Viral / Q000235:genetics; D015774:Ganciclovir / Q000494:pharmacology; D006801:Humans; D016030:Kidney Transplantation / Q000009:adverse effects*; D008875:Middle Aged; D010865:Pilot Projects; D020123:Sirolimus / Q000627:therapeutic use*; D019562:Viral Load
D000998:Antiviral Agents; D015774:Ganciclovir; D020123:Sirolimus