論文

査読有り
2016年7月

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

NEPHROLOGY
  • Daiki Iwami
  • ,
  • Yayoi Ogawa
  • ,
  • Hiromi Fujita
  • ,
  • Ken Morita
  • ,
  • Hajime Sasaki
  • ,
  • Yuichiro Oishi
  • ,
  • Haruka Higuchi
  • ,
  • Kanako Hatanaka
  • ,
  • Nobuo Shinohara

21
開始ページ
63
終了ページ
66
記述言語
英語
掲載種別
研究論文(学術雑誌)
DOI
10.1111/nep.12767
出版者・発行元
WILEY-BLACKWELL

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.

Web of Science ® 被引用回数 : 4

リンク情報
DOI
https://doi.org/10.1111/nep.12767
PubMed
https://www.ncbi.nlm.nih.gov/pubmed/26970406
Web of Science
https://gateway.webofknowledge.com/gateway/Gateway.cgi?GWVersion=2&SrcAuth=JSTA_CEL&SrcApp=J_Gate_JST&DestLinkType=FullRecord&KeyUT=WOS:000383587500015&DestApp=WOS_CPL

エクスポート
BibTeX RIS