Resolution of Mild Ganciclovir-Resistant Cytomegalovirus Disease with Reduced-Dose Cidofovir and CMV-Hyperimmune Globulin
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 e...
Saved in:
| Main Authors: | , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Wiley
2014-01-01
|
| Series: | Journal of Transplantation |
| Online Access: | http://dx.doi.org/10.1155/2014/342319 |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1832549135433072640 |
|---|---|
| author | Samir J. Patel Samantha A. Kuten Richard J. Knight Dana M. Hong A. Osama Gaber |
| author_facet | Samir J. Patel Samantha A. Kuten Richard J. Knight Dana M. Hong A. Osama Gaber |
| author_sort | Samir J. Patel |
| collection | DOAJ |
| description | 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. |
| format | Article |
| id | doaj-art-fa7509de5ddb4c98863c8760decb1579 |
| institution | Kabale University |
| issn | 2090-0007 2090-0015 |
| language | English |
| publishDate | 2014-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of Transplantation |
| spelling | doaj-art-fa7509de5ddb4c98863c8760decb15792025-02-03T06:12:09ZengWileyJournal of Transplantation2090-00072090-00152014-01-01201410.1155/2014/342319342319Resolution of Mild Ganciclovir-Resistant Cytomegalovirus Disease with Reduced-Dose Cidofovir and CMV-Hyperimmune GlobulinSamir J. Patel0Samantha A. Kuten1Richard J. Knight2Dana M. Hong3A. Osama Gaber4Department of Pharmacy, Houston Methodist Hospital, 6565 Fannin Street, DB1-09, Houston, TX 77030, USADepartment of Pharmacy, Houston Methodist Hospital, 6565 Fannin Street, DB1-09, Houston, TX 77030, USADepartment of Surgery, Houston Methodist Hospital, 6550 Fannin Street, SM 1661A, Houston, TX 77030, USAJ. C. Walter Jr. Transplant Center, Houston Methodist Hospital, 6550 Fannin Street, SM 1201, Houston, TX 77030, USADepartment of Surgery, Houston Methodist Hospital, 6550 Fannin Street, SM 1661A, Houston, TX 77030, USAGanciclovir-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.http://dx.doi.org/10.1155/2014/342319 |
| spellingShingle | Samir J. Patel Samantha A. Kuten Richard J. Knight Dana M. Hong A. Osama Gaber Resolution of Mild Ganciclovir-Resistant Cytomegalovirus Disease with Reduced-Dose Cidofovir and CMV-Hyperimmune Globulin Journal of Transplantation |
| title | Resolution of Mild Ganciclovir-Resistant Cytomegalovirus Disease with Reduced-Dose Cidofovir and CMV-Hyperimmune Globulin |
| title_full | Resolution of Mild Ganciclovir-Resistant Cytomegalovirus Disease with Reduced-Dose Cidofovir and CMV-Hyperimmune Globulin |
| title_fullStr | Resolution of Mild Ganciclovir-Resistant Cytomegalovirus Disease with Reduced-Dose Cidofovir and CMV-Hyperimmune Globulin |
| title_full_unstemmed | Resolution of Mild Ganciclovir-Resistant Cytomegalovirus Disease with Reduced-Dose Cidofovir and CMV-Hyperimmune Globulin |
| title_short | Resolution of Mild Ganciclovir-Resistant Cytomegalovirus Disease with Reduced-Dose Cidofovir and CMV-Hyperimmune Globulin |
| title_sort | resolution of mild ganciclovir resistant cytomegalovirus disease with reduced dose cidofovir and cmv hyperimmune globulin |
| url | http://dx.doi.org/10.1155/2014/342319 |
| work_keys_str_mv | AT samirjpatel resolutionofmildganciclovirresistantcytomegalovirusdiseasewithreduceddosecidofovirandcmvhyperimmuneglobulin AT samanthaakuten resolutionofmildganciclovirresistantcytomegalovirusdiseasewithreduceddosecidofovirandcmvhyperimmuneglobulin AT richardjknight resolutionofmildganciclovirresistantcytomegalovirusdiseasewithreduceddosecidofovirandcmvhyperimmuneglobulin AT danamhong resolutionofmildganciclovirresistantcytomegalovirusdiseasewithreduceddosecidofovirandcmvhyperimmuneglobulin AT aosamagaber resolutionofmildganciclovirresistantcytomegalovirusdiseasewithreduceddosecidofovirandcmvhyperimmuneglobulin |