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

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Title: Successful treatment with foscarnet for ganciclovir-resistant cytomegalovirus infection in a kidney transplant recipient : A case report
Other Titles: GCV-resistant CMV treated by foscarnet
Authors: Iwami, Daiki Browse this author →KAKEN DB
Ogawa, Yayoi Browse this author
Fujita, Hiromi Browse this author
Morita, Ken Browse this author
Sasaki, Hajime Browse this author
Oishi, Yuichiro Browse this author
Higuchi, Haruka Browse this author
Hatanaka, Kanako Browse this author
Shinohara, Nobuo Browse this author →KAKEN DB
Keywords: BK polyoma virus nephropathy
cytomegalovirus
foscarnet-induced nephropathy
ganciclovir-resistant
kidney transplantation
Issue Date: Jul-2016
Publisher: Wiley
Journal Title: Nephrology
Volume: 21
Issue: Supplement S1
Start Page: 63
End Page: 66
Publisher DOI: 10.1111/nep.12767
PMID: 26970406
Abstract: 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.
Rights: This is the peer reviewed version of the following article: Iwami, D., Ogawa, Y., Fujita, H., Morita, K., Sasaki, H., Oishi, Y., Higuchi, H., Hatanaka, K., and Shinohara, N. (2016) Successful treatment with foscarnet for ganciclovir-resistant cytomegalovirus infection in a kidney transplant recipient: A case report. Nephrology, 21: 63–66, which has been published in final form at http://dx.doi.org/10.1111/nep.12767. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Self-Archiving.
Type: article (author version)
URI: http://hdl.handle.net/2115/66406
Appears in Collections:医学院・医学研究院 (Graduate School of Medicine / Faculty of Medicine) > 雑誌発表論文等 (Peer-reviewed Journal Articles, etc)

Submitter: 岩見 大基

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