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High incidence of anticytomegalovirus drug resistance among D+R- kidney transplant recipients receiving preemptive therapy.
Couzi L., Helou S., Bachelet T., Moreau K., Martin S. et al
American Journal of Transplantation 12, 1 (2012) 202-9 - http://hal.archives-ouvertes.fr/hal-00675701
Sciences du Vivant/Microbiologie et Parasitologie
High incidence of anticytomegalovirus drug resistance among D+R- kidney transplant recipients receiving preemptive therapy.
L. Couzi, S. Helou, T. Bachelet, K. Moreau, S. Martin1, D. Morel, M. E. Lafon, B. Boyer2, S. Alain3, I. Garrigue4, P. Merville
1 :  LBP - Laboratoire de Biophotonique et Pharmacologie - UMR 7213
http://www.unistra.fr/index.php?id=1822
CNRS : UMR7213
Faculté de Pharmacie 74 route du Rhin - BP 60024 67401 ILLKIRCH CEDEX
France
2 :  IPNO - Institut de Physique Nucléaire d'Orsay
http://ipnweb.in2p3.fr
CNRS : UMR8608 – IN2P3 – Université Paris XI - Paris Sud
IPN - 15, rue Georges Clemenceau - 91406 ORSAY CEDEX
France
3 :  Teaching hospital
Teaching hospital
Limoges
France
4 :  MCMP - Microbiologie cellulaire et moléculaire et pathogénicité
http://www.u-bordeaux2.fr/recherche/labos/baltz.html
CNRS : UMR5234 – Université Victor Segalen - Bordeaux II
Bât. 3A - 1er etg 146 Rue Léo Saignat - 103 33076 BORDEAUX CEDEX
France
Anti-cytomegalovirus (CMV) prophylaxis is recommended in D+R- kidney transplant recipients (KTR), but is associated with a theoretical increased risk of developing anti-CMV drug resistance. This hypothesis was retested in this study by comparing 32 D+R- KTR who received 3 months prophylaxis (valganciclovir) with 80 D+R- KTR who received preemptive treatment. The incidence of CMV infections was higher in the preemptive group than in the prophylactic group (60% vs. 34%, respectively; p = 0.02). Treatment failure (i.e. a positive DNAemia 8 weeks after the initiation of anti-CMV treatment) was more frequent in the preemptive group (31% vs. 3% in the prophylactic group; p = 0.001). Similarly, anti-CMV drug resistance (UL97 or UL54 mutations) was also more frequent in the preemptive group (16% vs. 3% in the prophylactic group; p = 0.05). Antiviral treatment failures were associated with anti-CMV drug resistance (p = 0.0001). Patients with a CMV load over 5.25 log(10) copies/mL displayed the highest risk of developing anti-CMV drug resistance (OR = 16.91, p = 0.0008). Finally, the 1-year estimated glomerular filtration rate was reduced in patients with anti-CMV drug resistance (p = 0.02). In summary, preemptive therapy in D+R- KTR with high CMV loads and antiviral treatment failure was associated with a high incidence of anti-CMV drug resistance.
Anglais

American Journal of Transplantation (Am J Transplant)
Publisher Wiley-Blackwell
ISSN 1600-6135 (eISSN : 1600-6143)
internationale
Articles dans des revues avec comité de lecture
01/2012
03/10/2011
12
1
202-9