Publications [#191228] of Aimee K Zaas

Papers Published

1. AJ Reddy, AK Zaas, KE Hanson, SM Palmer, A single-center experience with ganciclovir-resistant cytomegalovirus in lung transplant recipients: treatment and outcome., The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation, vol. 26 no. 12 (December, 2007), pp. 1286-92, ISSN 1557-3117 [doi]
   (last updated on 2011/05/02)

   Abstract:
   BACKGROUND: Cytomegalovirus (CMV) disease is a major cause of morbidity and mortality after lung transplantation despite ganciclovir prophylaxis. The emergence of ganciclovir-resistant CMV in lung transplant patients has been reported, although the optimal strategy for the management of these infections remains uncertain. A review of the results of glanciclovir susceptibility testing in lung transplant recipients was performed. METHODS: We found 54% (113 of 210) of lung transplant patients developed CMV infection over a 4-year study period with ganciclovir-resistant CMV infection occurring in >5% of patients (6 of 113). The demographic and clinical characteristics of patients who developed ganciclovir-resistant vs -sensitive CMV infection were similar, although 50% (3 of 6) patients who developed resistance were CMV mismatched (D(+)/R(-) serology). All patients' CMV isolates had mutations in the UL97 gene. In addition, the 3 mismatch patients also had CMV with mutations in the UL54 gene. RESULTS: Treatment with a combination of foscarnet and ganciclovir or foscarnet alone for ganciclovir-resistant infection led to a significant reduction in virologic load in all patients (p = 0.03), although transient increases in viremia were observed in some patients early after treatment. Renal function worsened after treatment, but overall it was not significantly different from pre-treatment values (p = 0.07). CONCLUSIONS: Single or combination therapy with foscarnet is effective for treatment of ganciclovir-resistant isolates and excessive concern regarding toxicity should not preclude consideration of these treatments when clinically indicated.

   Keywords:
   Adult • Antiviral Agents • Cytomegalovirus • Cytomegalovirus Infections • Drug Resistance, Viral • Drug Therapy, Combination • Female • Foscarnet • Ganciclovir • Genetic Predisposition to Disease • Humans • Lung Transplantation* • Male • Middle Aged • Mutation • Opportunistic Infections • Phosphotransferases (Alcohol Group Acceptor) • Postoperative Complications* • Retrospective Studies • Treatment Outcome • drug therapy* • etiology • genetics • therapeutic use*