Preemptive therapy does not reduce ganciclovir-resistant CMV after lung transplant

NEW YORK (Reuters Health) – Contrary to what has been thought, preemptive therapy does not diminish the incidence of ganciclovir-resistant cytomegalovirus (CMV) infections among lung transplant recipients, according to a report in the January 1st issue of The Journal of Infectious Diseases.

Preemptive therapy, guided by CMV antigenemia, and routine prophylaxis with ganciclovir have been used in an effort to prevent the emergence of CMV disease in lung transplant recipients, the authors explain. "Because the incidence of ganciclovir-resistant CMV infection among organ transplant recipients who receive routine prophylaxis…is high, a preemptive strategy has been thought to be less likely to lead to antiviral resistance."

Dr. Ajit P. Limaye, from the University of Washington in Seattle, and colleagues studied the incidence and characteristics of ganciclovir-resistant CMV infection among 45 lung transplant recipients–34 recipients were CMV-positive (R+), while 11 recipients who were CMV-negative received organs from CMV-positive donors (D+/R-).

Ganciclovir-resistant CMV infection developed in three D+/R- patients and one R+ patient, the investigators report. One of the D+/R- patients had received prophylactic ganciclovir, the other three patients had received preemptive therapy.

"Ganciclovir resistance is now an important clinical problem in lung transplant patients, and clinicians should be alert for this complication, particularly in CMV seronegative recipients of transplants from seropositive donors (so called D+/R- patients)," Dr. Limaye told Reuters Health. "Current regimens of antiviral prophylaxis used in lung transplant patients may need to be reevaluated in light of the incidence of this complication."

"The hope is that earlier initiation of prophylaxis with more fully suppressive regimens of antiviral agents would prevent the emergence of resistance," Dr. Limaye added. "Studies looking at different dosing regimens for longer periods are currently under study in lung transplant patients to see whether this would decrease the incidence of resistance."

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