High incidence of anticytomegalovirus drug resistance among D+R- kidney transplant recipients receiving preemptive therapy.

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 log(10) 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.
Document type :
Journal articles
American Journal of Transplantation, Wiley-Blackwell, 2012, 12 (1), pp.202-9. <10.1111/j.1600-6143.2011.03766.x>


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Submitted on : Thursday, March 1, 2012 - 5:19:48 PM
Last modification on : Thursday, March 1, 2012 - 5:19:48 PM

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L. Couzi, S. Helou, T. Bachelet, K. Moreau, S. Martin, et al.. High incidence of anticytomegalovirus drug resistance among D+R- kidney transplant recipients receiving preemptive therapy.. American Journal of Transplantation, Wiley-Blackwell, 2012, 12 (1), pp.202-9. <10.1111/j.1600-6143.2011.03766.x>. <hal-00675701>

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