Fisher et al reported prognostic factors for a solid organ transplant recipient with ganciclovir resistant cytomegalovirus (CMV). The authors are from the University of Washington in Seattle.
Patient selection: solid organ transplant recipient with cytomegalovirus infection
Criteria for the diagnosis of ganciclovir resistant CMV:
(1) one or both of the following
(1a) failure to achieve at least 1 LOG10 reduction in CMV viral load despite >= 2 weeks of ganciclovir or valganciclovir in an appropriate dose
(1b) failure to show significant clinical improvement despite >= 2 weeks of ganciclovir or valganciclovir in an appropriate dose
(2) presence of mutations in UL54 or UL 97
Risk factors for development of ganciclovir resistance:
(1) male sex
(2) greater number of days of ganciclovir exposure prior to CMV diagnosis
(3) higher peak viral load
Predictors of morbidity:
(1) longer time to clearance of viremia
(2) >= 20% decrease in GFR at 3 months
(3) fewer well days in the 3 months after CMV diagnosis
(4) kidney rejection within 1 year
A patient infected with ganciclovir resistant CMV had a 1-year mortality rate of 16% versus 6% without resistance.
