Chemaly et al identified risk factors for antiviral resistance in cytomegalovirus infecting transplant recipients. The authors are from multiple institutions in the United States and Europe.
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Term
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Type
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Criteria
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refractory
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clinical
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suboptimal response to therapy
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resistant
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laboratory
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(1) drug resistant growth or (2) mutations associated with resistance
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Risk factors for resistance:
(1) donor CMV-seropositive; recipient CMV-seronegative solid organ transplant
(2) organ transplanted (lung highest)
(3) haploidentical, allogeneic or cord blood hematopoietic cell transplant
(4) lower dose of anti-CMV drug
(5) prolonged exposure to antiviral drugs (> 3 months)
(6) previous exposure to anti-CMV drug
(7) subtherapeutic anti-CMV drug levels (poor absorption, increased clearance, inadequate prodrug conversion)
(8) poor patient compliance with antiviral drug regimens
(9) more intense immunosuppression
(10) treatment with antithymocyte antibodies
(11) congenital immunodeficiency syndrome
(12) T-cell depletion
(13) delayed immune reconstitution
(14) high CMV viral load
(15) recurrent CMV infection
(16) active graft vs host disease (GVHD)
(17) young age
where:
• In Table 1 CMV seronegative donor and CMV seropositive recipient is stated.
