The use of sirolimus in ganciclovir-resistant cytomegalovirus infections in renal transplant recipients

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Ozaki, Kikumi Suzete
Camara, Niels Olsen Saraiva
Nogueira, Eliana
Pereira, Mauricio Galvao
Granato, Celso
Melaragno, Claudio
Camargo, Luis Fernando Aranha
Pacheco-Silva, Alvaro
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Background: the widespread use of prophylactic ganciclovir and anti-lymphocyte/thymocyte therapies are associated with increased induction of ganciclovir-resistant cytomegalovirus (CMV) strains. the use of sirolimus has been associated with a lower incidence of CMV infection in transplant recipients. We questioned whether it could also be effective as a therapeutic treatment of resistant CMV infection.Methods: Patients with ganciclovir-resistant CMV infections determined clinically and by DNA sequencing analysis were enrolled. Antigenaemia and DNA sequencing were used to diagnosis and follow the mutations.Results: Nine transplant patients were given sirolimus plus mycophenolate mofetil (n = 4) or a calcineurin inhibitor (n = 5). Seven out of nine recipients were CMV IgG negative before transplantation. We observed a rapid decrease in antigenaemia levels, reaching zero in eight out of nine (88.9%) patients within a median of 20.3 +/- 10.1 d. Graft function remained stable and no patient presented acute rejection or recurrence of the CMV infection.Conclusions: This suggests that the use of sirolimus plus ganciclovir therapy could be useful in ganciclovir-resistant CMV infections.
Clinical Transplantation. Oxford: Blackwell Publishing, v. 21, n. 5, p. 675-680, 2007.