Successful treatment with foscarnet for ganciclovir‐resistant cytomegalovirus infection in a kidney transplant recipient: A case report

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書誌事項

タイトル別名
  • Successful treatment with foscarnet for ganciclovir-resistant cytomegalovirus infection in a kidney transplant recipient : A case report
  • GCV-resistant CMV treated by foscarnet

説明

Cytomegalovirus (CMV) infection is themost common infectious complication following solid organ transplantation. Ganciclovir (GCV)-resistant CMV infection may be fatal, and is difficult to treat while avoiding allograft rejection. A 31-year-old woman received a second ABO-incompatible kidney transplant, from her father. Induction therapy consisted of basiliximab and rituximab followed by maintenance immunosuppression with tacrolimus, mycophenolate mofetil, and methylprednisolone. Her CMV serostatus was D+/R- at second transplant and she received prophylactic low-dose valganciclovir (VGCV). BK polyoma virus nephropathy (BKVN) developed 7 months after transplant concurrent with CMV hepatitis and retinitis. VGCV was increased to a therapeutic dose combined with reduced immunosuppression with minimal methylprednisolone (2mg/day) and everolimus (0.5mg/day). However, pp65 antigenaemia continued to increase for 6 weeks. Her CMV was defined as ganciclovir (GCV)-resistant. Foscarnet was therefore administered and her CMV disease resolved within 2 weeks. Kidney allograft dysfunction developed 9 months after transplant, and graft biopsy showed tubulointerstitial injury with crystal deposition suggesting foscarnet nephrotoxicity, with no findings of BKVN or rejection. Kidney function recovered after cessation of foscarnet and the patient had good graft function 18 months after transplant. This case demonstrates the successful use of foscarnet to treat GCV-resistant CMV infection after ABO-incompatible kidney transplant complicated with BKVN, without acute allograft rejection. This case further highlights the need to establish appropriate management for CMV D+/R- patients to avoid the acquisition of GCV-resistant gene mutations.

収録刊行物

  • Nephrology

    Nephrology 21 (S1), 63-66, 2016-07

    Wiley

キーワード

詳細情報 詳細情報について

  • CRID
    1050282813998582528
  • NII論文ID
    120006313438
  • DOI
    10.1111/nep.12767
  • ISSN
    14401797
    13205358
  • HANDLE
    2115/66406
  • PubMed
    26970406
  • 本文言語コード
    en
  • 資料種別
    journal article
  • データソース種別
    • IRDB
    • CiNii Articles
    • OpenAIRE

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