Subtherapeutic ganciclovir (GCV) levels and GCV-resistant cytomegalovirus in lung transplant recipients Journal Article

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Authors: Gagermeier, J. P.; Rusinak, J. D.; Lurain, N. S.; Alex, C. G.; Dilling, D. F.; Wigfield, C. H.; Love, R. B.
Article Title: Subtherapeutic ganciclovir (GCV) levels and GCV-resistant cytomegalovirus in lung transplant recipients
Abstract: BACKGROUND: Cytomegalovirus (CMV) infection results in significant morbidity and mortality in lung transplant recipients. Ganciclovir (GCV) has dramatically reduced complications caused by CMV infections. Unfortunately, GCV resistance is identified in 5-10% of CMV-infected patients. Mismatched CMV status and ongoing replication due to immunosuppression are risk factors for drug resistance. Whether subtherapeutic GCV levels contribute to resistance remains unknown. METHODS: A retrospective review was conducted in all 51 patients who underwent lung transplantation between March 2007 and June 2008 at Loyola University Medical Center. GCV resistance and outcome data of CMV-infected patients were analyzed to identify variables that may contribute to suboptimal response to CMV infection. RESULTS: During the 16-month period, CMV infection was identified in 21 of 51 lung transplant recipients. Ten of 21 patients (47.6%) had CMV infection with early response to GCV, and 11 patients (52.4%) had CMV infection with suboptimal response to GCV. GCV levels were obtained in the 11 CMV-infected patients with suboptimal response. In 6 patients, GCV levels were therapeutic; all 6 had delayed response to GCV. In 5 patients, GCV levels were subtherapeutic; each had persistent suboptimal response to GCV. Genotyping documented GCV-resistant (GCV-R) CMV in all 5 patients. Cystic fibrosis as the diagnosis requiring lung transplantation was associated with GCV-R CMV infection (P = 0.01). CONCLUSION: In our lung transplant recipient cohort, GCV levels were subtherapeutic in all patients with persistent suboptimal response to GCV, each of whom had GCV-R CMV infection. In contrast, GCV levels were therapeutic in CMV-infected patients with delayed GCV response.
Journal Title: Transplant infectious disease : an official journal of the Transplantation Society
Volume: 16
Issue: 6
ISSN: 1399-3062; 1398-2273
Publisher: Wiley Periodicals, Inc  
Journal Place: Denmark
Date Published: 2014
Start Page: 941
End Page: 950
Language: eng
DOI/URL:

10.1111/tid.12317
Notes: CI: (c) 2014; JID: 100883688; OTO: NOTNLM; 2013/05/19 [received]; 2014/08/20 [revised]; 2014/09/14 [accepted]; 2014/12/10 [aheadofprint]; ppublish
LUC Authors
  1. Daniel Dilling
    37 Dilling
  2. James Gagermeier
    4 Gagermeier
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