Resistant cytomegalovirus infection in renal transplant recipients

Abstract

Resistant cytomegalovirus infection is a significant problem in the transplant population including renal transplant recipients. A combination of factors including receipt of potent immunosuppression, high viral loads and suboptimal levels of anti-cytomegalovirus antivirals leads to emergence of resistant strains. Reports of associated poor graft survival and mortality demonstrate the potential pathogenic nature of such strains. Genotypic and phenotypic resistance testing are available for laboratory diagnosis of resistant cytomegalovirus infection and may help guide therapy. Various agents, including novel and newly minted antivirals and treatment approaches have been employed, with variable success. Thus, in spite of major advances in both diagnostics and therapeutics, management of resistant cytomegalovirus infection in renal transplant recipients remains a challenging prospect.