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The use of sirolimus in ganciclovir‐resistant cytomegalovirus infections in renal transplant recipients
Author(s) -
Ozaki Kikumi Suzete,
Câmara Niels Olsen Saraiva,
Nogueira Eliana,
Pereira Mauricio Galvão,
Granato Celso,
Melaragno Cláudio,
Camargo Luis Fernando Aranha,
PachecoSilva Alvaro
Publication year - 2007
Publication title -
clinical transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.918
H-Index - 76
eISSN - 1399-0012
pISSN - 0902-0063
DOI - 10.1111/j.1399-0012.2007.00699.x
Subject(s) - ganciclovir , medicine , sirolimus , cytomegalovirus , transplantation , betaherpesvirinae , calcineurin , foscarnet , immunology , valaciclovir , immunosuppression , human cytomegalovirus , gastroenterology , herpesviridae , virus , viral disease
Background: The widespread use of prophylactic ganciclovir and anti‐lymphocyte/thymocyte therapies are associated with increased induction of ganciclovir‐resistant cytomegalovirus (CMV) strains. The use of sirolimus has been associated with a lower incidence of CMV infection in transplant recipients. We questioned whether it could also be effective as a therapeutic treatment of resistant CMV infection. Methods: Patients with ganciclovir‐resistant CMV infections determined clinically and by DNA sequencing analysis were enrolled. Antigenaemia and DNA sequencing were used to diagnosis and follow the mutations. Results: Nine transplant patients were given sirolimus plus mycophenolate mofetil (n = 4) or a calcineurin inhibitor (n = 5). Seven out of nine recipients were CMV IgG negative before transplantation. We observed a rapid decrease in antigenaemia levels, reaching zero in eight out of nine (88.9%) patients within a median of 20.3 ± 10.1 d. Graft function remained stable and no patient presented acute rejection or recurrence of the CMV infection. Conclusions: This suggests that the use of sirolimus plus ganciclovir therapy could be useful in ganciclovir‐resistant CMV infections.