High Incidence of Anticytomegalovirus Drug Resistance Among D+R− Kidney Transplant Recipients Receiving Preemptive Therapy

Authors

  • L. Couzi,

    1. Centre Hospitalier Universitaire de Bordeaux, Hôpital Pellegrin, 33076 Bordeaux, France
    2. Centre National de la Recherche Scientifique (CNRS)-–Unité Mixte de Recherche (UMR) 5164, 146 rue Léo Saignat, 33076 Bordeaux, France
    3. Université Bordeaux Segalen, 146 rue Léo Saignat, 33076 Bordeaux, France
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    • These authors contributed equally to this work.

  • S. Helou,

    1. Centre Hospitalier Universitaire de Bordeaux, Hôpital Pellegrin, 33076 Bordeaux, France
    2. Université Bordeaux Segalen, 146 rue Léo Saignat, 33076 Bordeaux, France
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    • These authors contributed equally to this work.

  • T. Bachelet,

    1. Centre Hospitalier Universitaire de Bordeaux, Hôpital Pellegrin, 33076 Bordeaux, France
    2. Université Bordeaux Segalen, 146 rue Léo Saignat, 33076 Bordeaux, France
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  • K. Moreau,

    1. Centre Hospitalier Universitaire de Bordeaux, Hôpital Pellegrin, 33076 Bordeaux, France
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  • S. Martin,

    1. Centre Hospitalier Universitaire de Bordeaux, Hôpital Pellegrin, 33076 Bordeaux, France
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  • D. Morel,

    1. Centre Hospitalier Universitaire de Bordeaux, Hôpital Pellegrin, 33076 Bordeaux, France
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  • M. E. Lafon,

    1. Centre Hospitalier Universitaire de Bordeaux, Hôpital Pellegrin, 33076 Bordeaux, France
    2. Université Bordeaux Segalen, 146 rue Léo Saignat, 33076 Bordeaux, France
    3. CNRS-–UMR 5234, 146 rue Léo Saignat, 33076 Bordeaux, France
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  • B. Boyer,

    1. CHU Limoges, Laboratoire de Bactériologie-Virologie, Centre National de Référence des Cytomégalovirus, Limoges, France
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  • S. Alain,

    1. CHU Limoges, Laboratoire de Bactériologie-Virologie, Centre National de Référence des Cytomégalovirus, Limoges, France
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  • I. Garrigue,

    1. Centre Hospitalier Universitaire de Bordeaux, Hôpital Pellegrin, 33076 Bordeaux, France
    2. Université Bordeaux Segalen, 146 rue Léo Saignat, 33076 Bordeaux, France
    3. CNRS-–UMR 5234, 146 rue Léo Saignat, 33076 Bordeaux, France
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  • P. Merville

    1. Centre Hospitalier Universitaire de Bordeaux, Hôpital Pellegrin, 33076 Bordeaux, France
    2. Centre National de la Recherche Scientifique (CNRS)-–Unité Mixte de Recherche (UMR) 5164, 146 rue Léo Saignat, 33076 Bordeaux, France
    3. Université Bordeaux Segalen, 146 rue Léo Saignat, 33076 Bordeaux, France
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*Lionel Couzi, lionel.couzi@chu-bordeaux.fr

Abstract

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.

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