Table 3. Data at the onset and beyond the suspicion of resistance.
| Variables | Overall | Without Mutations | With Mutations | P value |
|---|---|---|---|---|
| (n = 44) | (n = 28) | (n = 16) | ||
| Time interval between transplantation and suspicion, median (IQR), days | 116.5 (60.0; 232.5) | 108.5 (43.5; 201.5) | 211.5 (87.5; 285.0) | 0.038 |
| Days of therapy before suspicion, median (IQR) | 20.0 (15.0; 48.0) | 16.0 (14.5; 22.5) | 41.5 (18.0;75.5) | 0.024 |
| Treatment at the time of suspicion, n (%) | ||||
| Preemptive treatment | 28 (63.5) | 21 (75.0) | 7 (43.8) | 0.038 |
| Disease treatment | 15 (34.1) | 7 (25.0) | 8 (50.0) | 0.092 |
| Prophylaxis | 1 (2.3) | 0 (0) | 1 (6.3) | 0.36 |
| CMV viral load at the time of suspicion, median (IQR), copies/ml | 11,304 (3,521; 64,105) | 7,088 (2,415; 47,555) | 36,236 (9,609; 65,247) | 0.17 |
| Symptoms at the time of suspicion, n (%)a | 24 (54.5) | 14 (50) | 10 (62) | 0.53 |
| Viral syndromeb | 13 (29.5) | 10 (35.7) | 3 (18.8) | 0.31 |
| Gastrointestinal diseasec | 8 (18.2) | 3 (10.7) | 5 (31.3) | 0.12 |
| Pneumonitis | 4 (9.1) | 2 (7.1) | 2 (12.5) | 0.61 |
| Retinitis | 2 (4.5) | 2 (7.1) | 0 (0) | 0.53 |
| Hepatitis | 1 (2.3) | 1 (3.6) | 0 (0) | >0.99 |
| Disseminated (>1 end organ) | 1 (2.3) | 0 (0) | 1 (6.3) | 0.36 |
| Therapeutic strategy on suspicion, n (%)d | ||||
| Increase GCV/VGC dose | 15 (34.1) | 10 (35.7) | 5 (31.3) | 0.764 |
| Continue with standard GCV/VGCe dose | 18 (40.9) | 13 (46.4) | 5 (31.3) | 0.325 |
| Decreased immunosuppression | 12 (27.3) | 6 (21.4) | 6 37.5) | 0.303 |
| Switch or add mTOR inhibitors | 11 (25.0) | 3 (10.7) | 8 (50.0) | 0.009 |
| Switch or add foscanet | 8 (18.2) | 3 (10.7) | 5 (31.3) | 0.12 |
| Outcome (at 3 months) | ||||
| Viral response | ||||
| Total suppression of CMV replication | 25 (56.8) | 18 (64.3) | 7 (43.8) | 0.186 |
| Incomplete suppression | 19 (43.2) | 10 (35.7) | 9 (56.3) | 0.156 |
| Final outcomef | ||||
| Graft rejection | 5 (11.9) | 3 (11.1) | 2 (13.3) | >0.99 |
| Death | 5 (11.9) | 3 (11.1) | 2 (13.3) | >0.99 |
Abbreviations: IQR, interquartile range; mTOR, mammalian target of rapamycin; n, number of case
a May have had more than 1 symptom at the time of suspicion
b Viral syndrome: fever >38°C(for at least 2 days in a 4 day period) associated with leucopenia, thrombocytopenia or increase in transaminases
c Gastrointestinal disease include: colitis, gastritis
d May have had more than 1 therapeutic strategy on suspicion
e Continue with standard prophylactic or treatment dose of GCV/VGC
fFinal outcome not specified in 2 patients