title: Resistant cytomegalovirus in intestinal and multivisceral transplant recipients.
abstract: BACKGROUND
  Intestinal and multivisceral transplantation can be complicated by cytomegalovirus (CMV)-related viremia and disease. Intravenous ganciclovir (GCV) and oral valganciclovir remain the treatment of choice in this setting. Limited data are available on GCV-resistant (GCV-R) CMV infection in small intestine and multivisceral transplant recipients.
  
  
  METHODS
  A retrospective review was performed on all patients who underwent small intestine or multivisceral transplantation from November 8, 2003 through November 30, 2008. Those with CMV viremia and invasive disease were identified. GCV resistance was suspected in patients who continued to have viremic episodes or invasive disease despite appropriate GCV treatment. Genotypic analyses were performed to detect the presence of GCV resistance genes UL97 and UL54.
  
  
  RESULTS
  During the study period, 88 small intestine or multivisceral transplants were performed on 85 patients. Of the 88 transplantations, 16 patients developed CMV viremia with or without end-organ disease (18.2%) and 5.7% developed GCV-R CMV infection. In patients diagnosed with CMV infection, 31.3% (5/16) had GCV-R CMV infection. Of patients with GCV-R CMV infection, 80% (4/5) developed CMV allograft enteritis, resulting in allograft explantation in 3 patients. All patients with GCV-R CMV infection were CMV donor positive/recipient negative. Patients with tissue-invasive CMV disease were 18 times more likely to be infected with GCV-R CMV (95% confidence interval 1.24-260.93; P-value 0.0341).
  
  
  CONCLUSIONS
  Small intestinal and multivisceral transplant recipients have a higher rate of GCV-R CMV infection compared with other solid organ transplant recipients, which is often associated with tissue-invasive disease and allograft loss.
authors: Division of Infectious Diseases and Travel Medicine, Department of Medicine, MedStar Georgetown University Hospital, Washington, DC, USA.
authors: J G
authors: JG
authors: Timpone
authors: Department of Cardiothoracic Surgery, Lenox Hill Hospital, New York, New York, USA.
authors: M
authors: M
authors: Yimen
authors: Division of Infectious Diseases and Travel Medicine, Department of Medicine, MedStar Georgetown University Hospital, Washington, DC, USA.
authors: S
authors: S
authors: Cox
authors: Division of Infectious Diseases and Travel Medicine, Department of Medicine, MedStar Georgetown University Hospital, Washington, DC, USA.
authors: R
authors: R
authors: Teran
authors: Division of Infectious Diseases and Travel Medicine, Department of Medicine, MedStar Georgetown University Hospital, Washington, DC, USA.
authors: S
authors: S
authors: Ajluni
authors: Infectious Diseases, Whitman-Walker Clinic, Washington, DC, USA.
authors: D
authors: D
authors: Goldstein
authors: Department of Surgery, MedStar Georgetown University Hospital, MedStar Georgetown Transplant Institute, Washington, DC, USA.
authors: T
authors: T
authors: Fishbein
authors: Division of Infectious Diseases and Travel Medicine, Department of Medicine, MedStar Georgetown University Hospital, Washington, DC, USA.
authors: P N
authors: PN
authors: Kumar
authors: Department of Surgery, MedStar Georgetown University Hospital, MedStar Georgetown Transplant Institute, Washington, DC, USA.
authors: C
authors: C
authors: Matsumoto
mesh_terms: D000293:Adolescent; D000328:Adult; D000998:Antiviral Agents / Q000494:pharmacology*; D002648:Child; D002675:Child, Preschool; D003587:Cytomegalovirus / Q000187:drug effects*; D003586:Cytomegalovirus Infections / Q000821:virology*; D005260:Female; D015774:Ganciclovir / Q000494:pharmacology*; D006801:Humans; D007166:Immunosuppressive Agents; D007223:Infant; D007422:Intestines / Q000637:transplantation*; D008297:Male; D008875:Middle Aged; D016377:Organ Transplantation / Q000009:adverse effects*; D012189:Retrospective Studies; D012307:Risk Factors; D055815:Young Adult
chemical_list: D000998:Antiviral Agents; D007166:Immunosuppressive Agents; D015774:Ganciclovir
keywords: cytomegalovirus; ganciclovir-resistance; multivisceral transplantation; small intestine transplantation; solid organ transplant