†These authors contributed equally to this work.
High Incidence of Anticytomegalovirus Drug Resistance Among D+R− Kidney Transplant Recipients Receiving Preemptive Therapy
Article first published online: 3 OCT 2011
©Copyright 2011 The American Society of Transplantation and the American Society of Transplant Surgeons
American Journal of Transplantation
Volume 12, Issue 1, pages 202–209, January 2012
How to Cite
Couzi, L., Helou, S., Bachelet, T., Moreau, K., Martin, S., Morel, D., Lafon, M. E., Boyer, B., Alain, S., Garrigue, I. and Merville, P. (2012), High Incidence of Anticytomegalovirus Drug Resistance Among D+R− Kidney Transplant Recipients Receiving Preemptive Therapy. American Journal of Transplantation, 12: 202–209. doi: 10.1111/j.1600-6143.2011.03766.x
- Issue published online: 13 JAN 2012
- Article first published online: 3 OCT 2011
- Received 06 May 2011, revised 06 July 2011 and accepted for publication 11 July 2011
- Antiviral resistance;
- cytomegalovirus (CMV);
- kidney transplantation;
- preemptive therapy;
Anti-cytomegalovirus (CMV) prophylaxis is recommended in D+R− kidney transplant recipients (KTR), but is associated with a theoretical increased risk of developing anti-CMV drug resistance. This hypothesis was retested in this study by comparing 32 D+R− KTR who received 3 months prophylaxis (valganciclovir) with 80 D+R− KTR who received preemptive treatment. The incidence of CMV infections was higher in the preemptive group than in the prophylactic group (60% vs. 34%, respectively; p = 0.02). Treatment failure (i.e. a positive DNAemia 8 weeks after the initiation of anti-CMV treatment) was more frequent in the preemptive group (31% vs. 3% in the prophylactic group; p = 0.001). Similarly, anti-CMV drug resistance (UL97 or UL54 mutations) was also more frequent in the preemptive group (16% vs. 3% in the prophylactic group; p = 0.05). Antiviral treatment failures were associated with anti-CMV drug resistance (p = 0.0001). Patients with a CMV load over 5.25 log10 copies/mL displayed the highest risk of developing anti-CMV drug resistance (OR = 16.91, p = 0.0008). Finally, the 1-year estimated glomerular filtration rate was reduced in patients with anti-CMV drug resistance (p = 0.02). In summary, preemptive therapy in D+R− KTR with high CMV loads and antiviral treatment failure was associated with a high incidence of anti-CMV drug resistance.