AUTHOR=Tamzali Yanis , Pourcher V. , Azoyan L. , Ouali N. , Barrou B. , Conti F. , Coutance G. , Gay F. , Tourret J. , Boutolleau D. 

TITLE=Factors Associated With Genotypic Resistance and Outcome Among Solid Organ Transplant Recipients With Refractory Cytomegalovirus Infection

JOURNAL=Transplant International

VOLUME=Volume 36 - 2023

YEAR=2023

URL=https://www.frontierspartnerships.org/journals/transplant-international/articles/10.3389/ti.2023.11295

DOI=10.3389/ti.2023.11295

ISSN=1432-2277

ABSTRACT=Purpose
We herein aimed at understanding the factors that predict CMV genotypic resistance in refractory infections and disease in the SOTR (Solid Organ Transplant Recipients) population, and the factors associated with outcome (one-year mortality and treatments adverse effects).
Methods
We included all SOTRs who were tested for CMV genotypic resistance for CMV refractory infec-tion/disease over ten years in two centers. 
Results
Eighty-one refractory patients were included, 26 with genotypically resistant infections (32 %). We found no resistance mutation to letermovir. Age (OR=0.94 per year, IC95 [0.089-0.99]), a history of valganciclovir (VGCV) underdosing or of low plasma concentration (OR= 5.6, IC95[1.69-20.7]), being on VGCV at infection onset (OR =3.11, IC95[1.18-5.32]) and the recipients’ CMV negative serostatus (OR=3.40, IC95 [0.97-12.8]) were independently associated with CMV genotypic resistance. The mortality rate at one year was significantly higher in the resistant CMV group (19.2 % versus 3.6 %, p=0.02). Antiviral drugs severe adverse effects were also independently associated with CMV genotypic resistance.
Conclusion
We found CMV genotypic resistance independently associated with a younger age, exposure to low levels of GCV, the recipients’ negative serostatus, presenting the infection on VGCV prophylaxis. We also find a poorer outcome in the patients of the resistant group.