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Subtherapeutic ganciclovir ( GCV ) levels and GCV ‐resistant cytomegalovirus in lung transplant recipients
Author(s) -
Gagermeier J.P.,
Rusinak J.D.,
Lurain N.S.,
Alex C.G.,
Dilling D.F.,
Wigfield C.H.,
Love R.B.
Publication year - 2014
Publication title -
transplant infectious disease
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.69
H-Index - 67
eISSN - 1399-3062
pISSN - 1398-2273
DOI - 10.1111/tid.12317
Subject(s) - medicine , ganciclovir , cytomegalovirus , lung transplantation , immunology , immunosuppression , transplantation , human cytomegalovirus , human immunodeficiency virus (hiv) , virus , viral disease , herpesviridae
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.