Clinical characteristics of 13 solid organ transplant recipients with ganciclovir-resistant cytomegalovirus infection

C. M. Isada, B. Yen-Lieberman, N. S. Lurain, R. Schilz, D. Kohn, D. L. Longworth, A. J. Taege, S. B. Mossad, J. Maurer, S. M. Flechner, S. D. Mawhorter, W. Braun, S. M. Gordon, S. K. Schmitt, M. Goldman, J. Long, M. Haug, Robin Avery

Research output: Contribution to journalArticle

Abstract

Background. Ganciclovir-resistant (GCV-R) cytomegalovirus (CMV) is now being reported with increasing frequency in solid organ transplant recipients. Objective. To describe the clinical characteristics and outcomes of all solid organ transplant patients with GCV-R CMV seen between 1990 and 2000 at a single center. Methods. Patients with clinically suspected GCV resistance had viral isolates subjected to phenotypic analysis by plaque reduction assay, and also genotypic analysis. Medical records of the 13 patients with GCV-R CMV were reviewed for demographic, microbiologic, clinical, and pathologic data. Results. Thirteen patients were identified, including 5 kidney, 1 heart, and 7 lung transplant recipients. All but one patient (92%) were CMV donor seropositive, recipient negative (D+/R-), and 11/13 (85%) had tissue-invasive CMV. CMV viremia was recurrent in 9/13 (69%); in 2 others, the first CMV episode was fatal. Overall, 9/13 (69%) of patients have died, all of CMV or its complications. Of the 10 who received foscarnet, only one survived. All patients had received GCV-based prophylactic regimens; 8/13 patients (62%) had received CMV hyperimmune globulin (CMVIG) as part of prophylaxis, 6/13 (46%) had received oral ganciclovir, and 5/13 (38%) had received intermittent (3×/week) IV ganciclovir for prophylaxis. Conclusions. GCV-R CMV is associated with CMV D+/R- status, tissue-invasive disease, and high mortality even with foscarnet therapy. Exposure to less than fully therapeutic levels of GCV, in the form of oral or intermittent IV GCV, is common. The use of CMVIG in prophylaxis does not appear to prevent resistance. Further work remains to be done to elucidate the risk factors and optimal mode of prophylaxis and treatment for GCV-R CMV.

Original languageEnglish (US)
Pages (from-to)189-194
Number of pages6
JournalTransplant Infectious Disease
Volume4
Issue number4
StatePublished - Dec 2002
Externally publishedYes

Fingerprint

Ganciclovir
Cytomegalovirus Infections
Cytomegalovirus
Transplants
Foscarnet
Globulins
Transplant Recipients
Viremia
Medical Records
Therapeutics

Keywords

  • Cytomegalovirus
  • Cytomegalovirus immune globulin
  • Foscarnet
  • Ganciclovir resistance
  • Solid organ transplantation

ASJC Scopus subject areas

  • Transplantation
  • Microbiology (medical)
  • Immunology

Cite this

Isada, C. M., Yen-Lieberman, B., Lurain, N. S., Schilz, R., Kohn, D., Longworth, D. L., ... Avery, R. (2002). Clinical characteristics of 13 solid organ transplant recipients with ganciclovir-resistant cytomegalovirus infection. Transplant Infectious Disease, 4(4), 189-194.

Clinical characteristics of 13 solid organ transplant recipients with ganciclovir-resistant cytomegalovirus infection. / Isada, C. M.; Yen-Lieberman, B.; Lurain, N. S.; Schilz, R.; Kohn, D.; Longworth, D. L.; Taege, A. J.; Mossad, S. B.; Maurer, J.; Flechner, S. M.; Mawhorter, S. D.; Braun, W.; Gordon, S. M.; Schmitt, S. K.; Goldman, M.; Long, J.; Haug, M.; Avery, Robin.

In: Transplant Infectious Disease, Vol. 4, No. 4, 12.2002, p. 189-194.

Research output: Contribution to journalArticle

Isada, CM, Yen-Lieberman, B, Lurain, NS, Schilz, R, Kohn, D, Longworth, DL, Taege, AJ, Mossad, SB, Maurer, J, Flechner, SM, Mawhorter, SD, Braun, W, Gordon, SM, Schmitt, SK, Goldman, M, Long, J, Haug, M & Avery, R 2002, 'Clinical characteristics of 13 solid organ transplant recipients with ganciclovir-resistant cytomegalovirus infection', Transplant Infectious Disease, vol. 4, no. 4, pp. 189-194.
Isada CM, Yen-Lieberman B, Lurain NS, Schilz R, Kohn D, Longworth DL et al. Clinical characteristics of 13 solid organ transplant recipients with ganciclovir-resistant cytomegalovirus infection. Transplant Infectious Disease. 2002 Dec;4(4):189-194.
Isada, C. M. ; Yen-Lieberman, B. ; Lurain, N. S. ; Schilz, R. ; Kohn, D. ; Longworth, D. L. ; Taege, A. J. ; Mossad, S. B. ; Maurer, J. ; Flechner, S. M. ; Mawhorter, S. D. ; Braun, W. ; Gordon, S. M. ; Schmitt, S. K. ; Goldman, M. ; Long, J. ; Haug, M. ; Avery, Robin. / Clinical characteristics of 13 solid organ transplant recipients with ganciclovir-resistant cytomegalovirus infection. In: Transplant Infectious Disease. 2002 ; Vol. 4, No. 4. pp. 189-194.
@article{ec361de18fb440bd9ae885084fdea3cb,
title = "Clinical characteristics of 13 solid organ transplant recipients with ganciclovir-resistant cytomegalovirus infection",
abstract = "Background. Ganciclovir-resistant (GCV-R) cytomegalovirus (CMV) is now being reported with increasing frequency in solid organ transplant recipients. Objective. To describe the clinical characteristics and outcomes of all solid organ transplant patients with GCV-R CMV seen between 1990 and 2000 at a single center. Methods. Patients with clinically suspected GCV resistance had viral isolates subjected to phenotypic analysis by plaque reduction assay, and also genotypic analysis. Medical records of the 13 patients with GCV-R CMV were reviewed for demographic, microbiologic, clinical, and pathologic data. Results. Thirteen patients were identified, including 5 kidney, 1 heart, and 7 lung transplant recipients. All but one patient (92{\%}) were CMV donor seropositive, recipient negative (D+/R-), and 11/13 (85{\%}) had tissue-invasive CMV. CMV viremia was recurrent in 9/13 (69{\%}); in 2 others, the first CMV episode was fatal. Overall, 9/13 (69{\%}) of patients have died, all of CMV or its complications. Of the 10 who received foscarnet, only one survived. All patients had received GCV-based prophylactic regimens; 8/13 patients (62{\%}) had received CMV hyperimmune globulin (CMVIG) as part of prophylaxis, 6/13 (46{\%}) had received oral ganciclovir, and 5/13 (38{\%}) had received intermittent (3×/week) IV ganciclovir for prophylaxis. Conclusions. GCV-R CMV is associated with CMV D+/R- status, tissue-invasive disease, and high mortality even with foscarnet therapy. Exposure to less than fully therapeutic levels of GCV, in the form of oral or intermittent IV GCV, is common. The use of CMVIG in prophylaxis does not appear to prevent resistance. Further work remains to be done to elucidate the risk factors and optimal mode of prophylaxis and treatment for GCV-R CMV.",
keywords = "Cytomegalovirus, Cytomegalovirus immune globulin, Foscarnet, Ganciclovir resistance, Solid organ transplantation",
author = "Isada, {C. M.} and B. Yen-Lieberman and Lurain, {N. S.} and R. Schilz and D. Kohn and Longworth, {D. L.} and Taege, {A. J.} and Mossad, {S. B.} and J. Maurer and Flechner, {S. M.} and Mawhorter, {S. D.} and W. Braun and Gordon, {S. M.} and Schmitt, {S. K.} and M. Goldman and J. Long and M. Haug and Robin Avery",
year = "2002",
month = "12",
language = "English (US)",
volume = "4",
pages = "189--194",
journal = "Transplant Infectious Disease",
issn = "1398-2273",
publisher = "Wiley-Blackwell",
number = "4",

}

TY - JOUR

T1 - Clinical characteristics of 13 solid organ transplant recipients with ganciclovir-resistant cytomegalovirus infection

AU - Isada, C. M.

AU - Yen-Lieberman, B.

AU - Lurain, N. S.

AU - Schilz, R.

AU - Kohn, D.

AU - Longworth, D. L.

AU - Taege, A. J.

AU - Mossad, S. B.

AU - Maurer, J.

AU - Flechner, S. M.

AU - Mawhorter, S. D.

AU - Braun, W.

AU - Gordon, S. M.

AU - Schmitt, S. K.

AU - Goldman, M.

AU - Long, J.

AU - Haug, M.

AU - Avery, Robin

PY - 2002/12

Y1 - 2002/12

N2 - Background. Ganciclovir-resistant (GCV-R) cytomegalovirus (CMV) is now being reported with increasing frequency in solid organ transplant recipients. Objective. To describe the clinical characteristics and outcomes of all solid organ transplant patients with GCV-R CMV seen between 1990 and 2000 at a single center. Methods. Patients with clinically suspected GCV resistance had viral isolates subjected to phenotypic analysis by plaque reduction assay, and also genotypic analysis. Medical records of the 13 patients with GCV-R CMV were reviewed for demographic, microbiologic, clinical, and pathologic data. Results. Thirteen patients were identified, including 5 kidney, 1 heart, and 7 lung transplant recipients. All but one patient (92%) were CMV donor seropositive, recipient negative (D+/R-), and 11/13 (85%) had tissue-invasive CMV. CMV viremia was recurrent in 9/13 (69%); in 2 others, the first CMV episode was fatal. Overall, 9/13 (69%) of patients have died, all of CMV or its complications. Of the 10 who received foscarnet, only one survived. All patients had received GCV-based prophylactic regimens; 8/13 patients (62%) had received CMV hyperimmune globulin (CMVIG) as part of prophylaxis, 6/13 (46%) had received oral ganciclovir, and 5/13 (38%) had received intermittent (3×/week) IV ganciclovir for prophylaxis. Conclusions. GCV-R CMV is associated with CMV D+/R- status, tissue-invasive disease, and high mortality even with foscarnet therapy. Exposure to less than fully therapeutic levels of GCV, in the form of oral or intermittent IV GCV, is common. The use of CMVIG in prophylaxis does not appear to prevent resistance. Further work remains to be done to elucidate the risk factors and optimal mode of prophylaxis and treatment for GCV-R CMV.

AB - Background. Ganciclovir-resistant (GCV-R) cytomegalovirus (CMV) is now being reported with increasing frequency in solid organ transplant recipients. Objective. To describe the clinical characteristics and outcomes of all solid organ transplant patients with GCV-R CMV seen between 1990 and 2000 at a single center. Methods. Patients with clinically suspected GCV resistance had viral isolates subjected to phenotypic analysis by plaque reduction assay, and also genotypic analysis. Medical records of the 13 patients with GCV-R CMV were reviewed for demographic, microbiologic, clinical, and pathologic data. Results. Thirteen patients were identified, including 5 kidney, 1 heart, and 7 lung transplant recipients. All but one patient (92%) were CMV donor seropositive, recipient negative (D+/R-), and 11/13 (85%) had tissue-invasive CMV. CMV viremia was recurrent in 9/13 (69%); in 2 others, the first CMV episode was fatal. Overall, 9/13 (69%) of patients have died, all of CMV or its complications. Of the 10 who received foscarnet, only one survived. All patients had received GCV-based prophylactic regimens; 8/13 patients (62%) had received CMV hyperimmune globulin (CMVIG) as part of prophylaxis, 6/13 (46%) had received oral ganciclovir, and 5/13 (38%) had received intermittent (3×/week) IV ganciclovir for prophylaxis. Conclusions. GCV-R CMV is associated with CMV D+/R- status, tissue-invasive disease, and high mortality even with foscarnet therapy. Exposure to less than fully therapeutic levels of GCV, in the form of oral or intermittent IV GCV, is common. The use of CMVIG in prophylaxis does not appear to prevent resistance. Further work remains to be done to elucidate the risk factors and optimal mode of prophylaxis and treatment for GCV-R CMV.

KW - Cytomegalovirus

KW - Cytomegalovirus immune globulin

KW - Foscarnet

KW - Ganciclovir resistance

KW - Solid organ transplantation

UR - http://www.scopus.com/inward/record.url?scp=0036969325&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0036969325&partnerID=8YFLogxK

M3 - Article

C2 - 12535261

AN - SCOPUS:0036969325

VL - 4

SP - 189

EP - 194

JO - Transplant Infectious Disease

JF - Transplant Infectious Disease

SN - 1398-2273

IS - 4

ER -