title: Ganciclovir-Resistant Cytomegalovirus Infection in a Kidney Transplant Recipient Successfully Treated with Foscarnet and Everolimus.
abstract: Cytomegalovirus (CMV) infection remains a major cause of morbidity, graft failure, and death in kidney transplant recipients. We describe a case of a 53-year-old CMV-seronegative man who underwent renal transplant from a CMV-positive donor and who developed ganciclovir- (GCV-) resistant CMV infection. Foscarnet was started while immunosuppressive therapy was modified with the introduction of everolimus minimizing tacrolimus dosage. Only two weeks after the start of this treatment regimen was the patient's viral load negative. At two-year follow-up the patient has no clinical or laboratory signs of CMV infection and a good and stable renal function or graft survival. In our case, administration of an mTOR inhibitor combined with foscarnet led to rapid and persistent viral clearance without compromising short- and medium-term graft function. This combination therapy supports the need for the kidney transplant community to individualize a target therapy for each type of GCV-resistant CMV infection.
authors.affiliation: Department of Experimental, Diagnostic and Specialty Medicine, Nephrology, Dialysis and Transplantation Unit, St. Orsola Hospital, University of Bologna, 40138 Bologna, Italy.
authors.forename: Viola
authors.initials: V
authors.lastname: Menghi
authors.affiliation: Department of Experimental, Diagnostic and Specialty Medicine, Nephrology, Dialysis and Transplantation Unit, St. Orsola Hospital, University of Bologna, 40138 Bologna, Italy.
authors.forename: Giorgia
authors.initials: G
authors.lastname: Comai
authors.affiliation: Department of Experimental, Diagnostic and Specialty Medicine, Nephrology, Dialysis and Transplantation Unit, St. Orsola Hospital, University of Bologna, 40138 Bologna, Italy.
authors.forename: Olga
authors.initials: O
authors.lastname: Baraldi
authors.affiliation: Department of Experimental, Diagnostic and Specialty Medicine, Nephrology, Dialysis and Transplantation Unit, St. Orsola Hospital, University of Bologna, 40138 Bologna, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Liviano D'Arcangelo
authors.affiliation: Clinical Microbiology Unit, St. Orsola Hospital, University of Bologna, 40138 Bologna, Italy.
authors.forename: Tiziana
authors.initials: T
authors.lastname: Lazzarotto
authors.affiliation: Department of Experimental, Diagnostic and Specialty Medicine, Nephrology, Dialysis and Transplantation Unit, St. Orsola Hospital, University of Bologna, 40138 Bologna, Italy.
authors.forename: Gaetano
authors.initials: G
authors.lastname: La Manna