title: Ganciclovir-resistant cytomegalovirus infection in solid organ transplant recipients: a single-center retrospective cohort study.
abstract: BACKGROUND
  Ganciclovir-resistant cytomegalovirus (GCV-R CMV) is an emerging challenge among solid organ transplant (SOT) recipients. The literature suggests that about 1% of abdominal transplant recipients develop GCV-R CMV infection. The epidemiology and outcome of GCV-R CMV in SOT recipients who have received alemtuzumab induction is not well described.
  
  
  METHODS
  After Institutional Review Board approval, a single-center, retrospective review of 2148 abdominal SOT recipients between January 2006 and July 2011 at our institution (n = 2148) was conducted to identify patients with proven or empirically treated GCV-R CMV. Descriptive statistics on collected demographics, clinical course, and therapeutic outcomes were performed.
  
  
  RESULTS
  Of 116 SOT recipient treated for CMV, 14 patients (12.1% of cases; 0.65% of all SOT patients) had proven or suspected GCV-R CMV. Eight (50%) developed GCV-R CMV while receiving valganciclovir (valGCV) prophylaxis. The remainder developed late-onset disease, after having completed an average 212 days (range 83-353) of prophylaxis. Resistance was clinically suspected an average of 103 days (range 10-455) after CMV infection was initially identified; 10 patients had confirmed genotypic resistance. Foscarnet therapy was associated with resolution of CMV in 13.
  
  
  CONCLUSIONS
  Suboptimal dosing of valGCV is associated with development of GCV-R CMV. Our observed rate of GCV-R CMV in alemtuzumab-induced patients is similar to rates seen to historical data for other induction agents.
authors.affiliation: The Christ Hospital Infectious Diseases Physicians, Cincinnati, Ohio, USA.
authors.forename: P G
authors.initials: PG
authors.lastname: Young
authors.affiliation: University of Illinois at Chicago School of Medicine, Chicago, Illinois, USA.
authors.forename: J
authors.initials: J
authors.lastname: Rubin
authors.affiliation: Division of Infectious Diseases Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
authors.forename: M
authors.initials: M
authors.lastname: Angarone
authors.affiliation: Division of Infectious Diseases Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
authors.forename: J
authors.initials: J
authors.lastname: Flaherty
authors.affiliation: Division of Infectious Diseases Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
authors.forename: S
authors.initials: S
authors.lastname: Penugonda
authors.affiliation: Division of Infectious Diseases Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.|Division of Organ Transplantation, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
authors.forename: V
authors.initials: V
authors.lastname: Stosor
authors.affiliation: Division of Infectious Diseases Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.|Division of Organ Transplantation, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
authors.forename: M G
authors.initials: MG
authors.lastname: Ison
mesh_terms: D000328:Adult; D000368:Aged; D000074323:Alemtuzumab; D061067:Antibodies, Monoclonal, Humanized / Q000627:therapeutic use; D000998:Antiviral Agents / Q000627:therapeutic use*; D015331:Cohort Studies; D003141:Communicable Diseases; D003587:Cytomegalovirus / Q000187:drug effects* / Q000276:immunology; D003586:Cytomegalovirus Infections / Q000188:drug therapy* / Q000821:virology; D024882:Drug Resistance, Viral / Q000187:drug effects*; D005260:Female; D017245:Foscarnet / Q000627:therapeutic use; D015774:Ganciclovir / Q000031:analogs & derivatives / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008875:Middle Aged; D016377:Organ Transplantation / Q000009:adverse effects*; D012189:Retrospective Studies; D012307:Risk Factors; D000077562:Valganciclovir; D055815:Young Adult
chemical_list: D061067:Antibodies, Monoclonal, Humanized; D000998:Antiviral Agents; D017245:Foscarnet; D000074323:Alemtuzumab; D000077562:Valganciclovir; D015774:Ganciclovir
keywords: abdominal transplant; cytomegalovirus; ganciclovir-resistance; solid organ transplant