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Resolution of Mild Ganciclovir-Resistant Cytomegalovirus Disease with Reduced-Dose Cidofovir and CMV-Hyperimmune Globulin

Authors :
Dana M. Hong
Samir J. Patel
Samantha A. Kuten
A. Osama Gaber
Richard J. Knight
Source :
Journal of Transplantation, Vol 2014 (2014), Journal of Transplantation
Publication Year :
2014
Publisher :
Hindawi Publishing Corporation, 2014.

Abstract

Ganciclovir-resistant cytomegalovirus (CMV) is associated with significant morbidity in solid organ transplant recipients. Management of ganciclovir-resistant CMV may be complicated by nephrotoxicity which is commonly observed with recommended therapies and/or rejection induced by “indirect” viral effects or reduction of immunosuppression. Herein, we report a series of four high serologic risk (donor CMV positive/recipient CMV negative) kidney transplant patients diagnosed with ganciclovir-resistant CMV disease. All patients initially developed “breakthrough” viremia while still receiving valganciclovir prophylaxis after transplant and were later confirmed to exhibit UL97 mutations after failing to eradicate virus on adequate dosages of valganciclovir. The patients were subsequently and successfully treated with reduced-dose (1-2 mg/kg) cidofovir and CMV-hyperimmune globulin, given in 2-week intervals. In addition, all patients exhibited stable renal function after completion of therapy, and none experienced acute rejection. The combination of reduced-dose cidofovir and CMV-hyperimmune globulin appeared to be a safe and effective regimen in patients with mild disease due to ganciclovir-resistant CMV.

Details

Language :
English
ISSN :
20900007
Database :
OpenAIRE
Journal :
Journal of Transplantation
Accession number :
edsair.doi.dedup.....d5016c485d98622ea583d7586ea1aab0
Full Text :
https://doi.org/10.1155/2014/342319