Table 4. Clinical and virological data in solid organ transplant recipients with cytomegalovirus resistance mutations.
| Type of Transplant (CMV serostatus) | Induction therapy | Prophylaxis (months) | Treatment on suspicion of resistancea (Days) |
Symptomatic on suspicion of resistance | UL97/UL54 DRM (Days post-TX) | CMV viral b (copies/ml) |
Therapeutic adaptation on suspicion of resistance | Virological and/or clinical outcome c | |
|---|---|---|---|---|---|---|---|---|---|
| 1 | Kidney D+/R- | ATG | 3 M | Disease VGC 900mg/12h (16) | Suspected colitis | L595S (91) | 4.180 | GCV/VGC increased mTORi | IS. |
| 2 | Kidney D+/R+ | Basiliximab | No | Preemptive treatment VGC 450mg/12h (15) | No | M460V (68) | 55.253 | GCV/VGC increased | CS.Total resolution |
| 3 | Liver D+/R- | No | No | Preemptive treatment VGC 450mg/12h(15) | No | A594V 63) | 9.300 | GCV/VGC increased ISP decreased | IS. Cell-mediated rejection |
| 4 | Liver D+/R- | No | 3M | Disease VGC 450mg/12h(15) | Viral syndromed, Suspected colitis | M460V (203) | 3.849 | ISP decreased Continue with GCV/VGCV | CS.Total resolution |
| 5 | Kidney D+/R+ | Basiliximab | 1M | Disease VGC 450mg/12h(84) | Suspected gastritis | M460V (235) | 11.234 | ISP decreased GCV/VGC increased mTORi | CS. Total resolution |
| 6 | Kidney D+/R+ | ATG | No | Disease VGC 450mg/12h(67) | Viral syndrome d Suspected colitis | L595S (58) | 114.167 | GCV/VGC increased | CS.Total resolution |
| 7 | Heart D+/R- | No | 3M | Disease VGC 100mg/12h (20) | Viral syndrome d | L595S (350) | 154.486 | GCV/VGC increased | IS |
| 8 | Kidney D+/R- | ATG | 3M | Disease VGC 450mg/12h(61) | Suspected colitis | C592G+M460V (102) | 11.605 | GCV/VGC increased. mTORi | IS |
| 9 | Lung D+/R- | No | 12M | Prophylaxis VGC 900mg/24h(38) | Confirmed pneumonitis | H520Q (210) | 33.772 | ISP Decreased. FOS. mTORi | CS.Total resolution |
| 10 | Lung D+/R- | No | 12M | Preemptive treatment VGC 900mg/12h(96) | No | M460V/P522A (335) | 68.494 | ISP Decreased .FOS. mTORi | IS |
| 11 | Lung D+/R- | No | 6M | Preemptive treatment VGC 900mg/12h(26) | No | L595S (210) | 38.700 | ISP Decreased .FOS. mTORi | CS.Total resolution |
| 12 | Liver D+/R- | No | No | Disease VGC 450mg/12h (45) | Confirmed pneumonitis and retinitis | M460V (340) | 9.919 | Continue with GCV/VGCV. mTORi | IS. Death |
| 13 | Lung D+/R- | Basiliximab | 12M | Preemptive treatment VGC 450mg/12h(231) | No | M460I/D413N (400) | 62.000 | GCV/VGC increased. Leflunomide | IS. Cell-mediated rejection |
| 14 | Heart D+/R- | Basiliximab | 1M | Preemptive treatment VGC 450mg/12h(113) | Viral syndromed | A594P (331) | 59.879 | Continue with GCV/VGCV. Maribavir | IS |
| 15 | Kidney D+/R- | No | 1M | Disease VGC 450mg/12h(28) | Viral syndromec Suspected colitis | L595S (112) | 721.000 | Switch to FOS | IS. Death |
| 16 | Heart D+/R- | Basiliximab | 2M | Preemptive treatment VGC 900mg/12h(51) | Viral syndromed | L595W+A594V (84) | 4.120 | GCV/VGC increased. FOS. mTORi | CS.Total resolution |
CMV, cytomegalovirus; D, donor; R, recipient; TX, transplantation; GCV, ganciclovir; VGC, valganciclovir; FOS, foscarnet, CDV, cidofovir; ATG, antithymocyte globulin; ISP, immunosuppression; IS, incomplete suppression; CS, total supression of CMV replication
aDrug/doses
bCMV viral load on suspicion of resistance
cVirological and clinical outcomes at 3 months
dPresence of fever >38°C (for at least 2 days in a 4 day period) associated with leucopenia, thrombocytopenia or an increase in transaminases