title: Case report: Brincidofovir-induced reversible severe acute kidney injury in 2 solid-organ transplant for treatment of cytomegalovirus infection.
abstract: BACKGROUND
  Resistant cytomegalovirus-mediated infections are increasing in solid organ recipient with few available alternative treatments. Brincidofovir is an oral broad-spectrum antiviral in development for prevention and treatment of viral infection, particularly cytomegalovirus.
  
  
  METHODS
  Although brincidofovir is an analogue of cidofovir, previous studies reported no renal toxicity.
  
  
  METHODS
  Here, we report 2 cases of severe tubular necrosis in solid organ recipients, 1 heart and 1 kidney transplant.
  
  
  METHODS
  Both patients received brincidofovir for the treatment of cytomegalovirus infection with mutation of UL-97. They presented an acute kidney injury without any occurrence of other clinical event such as introduction of nephrotoxic drug, graft rejection, urinary tract obstruction or infection, and calcineurin inhibitor overdosage. In each case, renal biopsy showed extended tubular necrosis.
  
  
  RESULTS
  The discontinuation of brincidofovir led to improve renal function without other any intervention. Reintroduction of brincidofovir in case 1, due to the absence of other medical alternative, led to a new episode of acute kidney injury. One more time, renal biopsy showed tubular necrosis and patient recovered renal function after discontinuation.
  
  
  CONCLUSIONS
  To our knowledge, this is the first report of brincidofovir-mediated renal adverse event. Clinicians may be aware of this severe complication in this specific population.
authors.affiliation: Service de Néphrologie et Transplantation Unité des maladies infectieuses, Hôpital Huriez, CHU de Lille, Lille Centre National de Référence du Cytomégalovirus, CHU de Limoges, Limoges Institut de Pathologie, Centre Biologie-Pathologie Hôpital Cardiologique Institut de microbiologie, Laboratoire de Virologie, Centre Biologie-Pathologie, CHU de Lille Centre Régional de Pharmacovigilance du Nord-Pas de Calais, CHU Lille Pharmacie hospitalière, CHRU de Lille, Lille, France.
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Faure
authors.forename: Tatiana
authors.initials: T
authors.lastname: Galperine
authors.forename: Olivier
authors.initials: O
authors.lastname: Cannesson
authors.forename: Sophie
authors.initials: S
authors.lastname: Alain
authors.forename: Viviane
authors.initials: V
authors.lastname: Gnemmi
authors.forename: Celine
authors.initials: C
authors.lastname: Goeminne
authors.forename: Annie
authors.initials: A
authors.lastname: Dewilde
authors.forename: Johana
authors.initials: J
authors.lastname: Béné
authors.forename: Mohamed
authors.initials: M
authors.lastname: Lasri
authors.forename: Célia
authors.initials: C
authors.lastname: Lessore de Sainte Foy
authors.forename: Arnaud
authors.initials: A
authors.lastname: Lionet
mesh_terms: D058186:Acute Kidney Injury / Q000139:chemically induced*; D000998:Antiviral Agents / Q000627:therapeutic use*; D003586:Cytomegalovirus Infections / Q000188:drug therapy*; D003596:Cytosine / Q000009:adverse effects / Q000031:analogs & derivatives*; D016027:Heart Transplantation; D006801:Humans; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D063065:Organophosphonates / Q000009:adverse effects*; D011183:Postoperative Complications / Q000188:drug therapy*; D012720:Severity of Illness Index
chemical_list: D000998:Antiviral Agents; D063065:Organophosphonates; C525733:brincidofovir; D003596:Cytosine