Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2022 Feb;24(1):e13733.
doi: 10.1111/tid.13733. Epub 2021 Oct 5.

Management of ganciclovir resistance cytomegalovirus infection with CMV hyperimmune globulin and leflunomide in seven cardiothoracic transplant recipients and literature review

Karthik Santhanakrishnan  1 , Nizar Yonan  1 , Kapil Iyer  1 , Paul Callan  1 , Mohamed Al-Aloul  1 , Rajamiyer Venkateswaran  1
Affiliations
Review

Management of ganciclovir resistance cytomegalovirus infection with CMV hyperimmune globulin and leflunomide in seven cardiothoracic transplant recipients and literature review

Karthik Santhanakrishnan et al. Transpl Infect Dis. 2022 Feb.

Abstract

Cytomegalovirus (CMV) disease caused by genetically resistant CMV poses a major challenge in solid organ transplant recipients, and the development of resistance is associated with increased morbidity and mortality. Antiviral resistance affects 5%-12% of patients following ganciclovir (GCV) therapy, but is more common in individuals with specific underlying risk factors. These include the CMV D+R- serostatus, type of transplanted organ, dose and duration of (Val)GCV ([V]GCV) prophylaxis, peak viral loads, and the intensity of immunosuppressive therapy. Guideline recommendations for the management of GCV resistance (GanR) in solid organ transplant recipients are based on expert opinion as there is a lack of data from controlled trials. Second-line options to treat GanR include foscarnet (FOS) and cidofovir (CDV), but these drugs are often poorly tolerated due to high rates of toxicity, such as renal dysfunction and neutropenia. Here, we report seven cardiothoracic transplant recipients with GCV resistance CMV infection from our centre treated with CMV immunoglobulin (CMVIG) +/- leflunomide (LEF) and reviewed the literature on the use of these agents in this therapeutic setting.

Keywords: CMV; CMVIG; heart transplant; lung transplant; resistance.

PubMed Disclaimer

References

REFERENCES

    1. Sepulveda L, Llancaqueo M, Zamorano J, Bermudez C, Cortes C. Cytomegalovirus infections in cardiac transplant patients: an experience at a clinical hospital, university of Chile. Transplant Proc. 2007;39(3):622-624.
    1. Fishman JA, Rubin RH. Infection in organ-transplant recipients. N Engl J Med. 1998;338(24):1741-1751.
    1. Kotton CN, Kumar D, Caliendo AM, et al. The third international consensus guidelines on the management of cytomegalovirus in solid-organ transplantation. Transplantation. 2018;102(6):900-931.
    1. Chemaly RF, Chou S, Einsele H, et al. Definitions of resistant and refractory cytomegalovirus infection and disease in transplant recipients for use in clinical trials. Clin Infect Dis. 2019;68(8):1420-1426.
    1. Andrei G, Van Loon E, Lerut E, et al. Persistent primary cytomegalovirus infection in a kidney transplant recipient: multi-drug resistant and compartmentalized infection leading to graft loss. Antiviral Res. 2019;168:203-209.

MeSH terms