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首页> 外文期刊>BMC Infectious Diseases >Emergence of Letermovir-resistant HCMV UL56 mutant during rescue treatment in a liver transplant recipient with ganciclovir-resistant infection HCMV: a case report
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Emergence of Letermovir-resistant HCMV UL56 mutant during rescue treatment in a liver transplant recipient with ganciclovir-resistant infection HCMV: a case report

机译：肝脏移植受体中泌乳治疗过程中Letermovir抗性HCMV UL56突变体的出现肝脏抗性感染HCMV：案例报告

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Human Cytomegalovirus (HCMV) still represents a crucial concern in solid organ transplant recipients (SOTRs) and the use of antiviral therapy are limited by side effects and the selection of viral mutations conferring antiviral drug resistance. Here we reported the case of an HCMV seronegative patient with common variable immunodeficiency (CVID), multiple hepatic adenomatosis, hepatopulmonary syndrome and portal hypertension who received a liver transplant from an HCMV seropositive donor.?The patient was treated with Valganciclovir (vGCV) and then IV Ganciclovir (GCV) at 5 week post-transplant for uncontrolled HCMV DNAemia. However, since mutation A594V in UL97 gene conferring resistance to ganciclovir was reported, GCV therapy was interrupted.?Due to the high toxicity of Foscarnet (FOS) and Cidofovir (CDV), Letermovir (LMV) monotherapy at the dosage of 480?mg per day was administered, with a gradual viral load reduction. However, a relapse of HCMV DNAemia revealed the presence of mutation C325Y in HCMV UL56 gene conferring resistance to LMV. In conclusion, even if LMV is an effective and favorable safety molecule it might have a lower genetic barrier to resistance. A warning on the use of LMV monotherapy as rescue treatments for HCMV GCV-resistant infections in transplant recipients is warranted.
机译：人巨细胞病毒（HCMV）仍然代表固体器官移植受者（SOTR）中的至关重要，并且抗病毒治疗的使用受副作用和赋予抗病毒耐药性的病毒突变的限制。在这里，我们报告了具有常见可变免疫缺陷（CVID）的HCMV血清患者的情况，多次肝胆症，肝癌综合征和门静脉高血压从HCMV血清阳性供体中接受肝脏移植。患者用VALGANCICLOVIR（VGCV），然后IV GANCICLOVIR（GCV）在移植后5周的不受控制的HCMV DNAEMIA。然而，由于据报道，由于UL97基因的突变A594V赋予抵抗性血清虫病毒，因此GCV疗法被中断了。以480Ω·Mg的剂量为480？Mg的植物（FOS）和Cidofovir（CDV）的高毒性。施用一天，逐渐减少病毒负荷。然而，HCMV DNAEMIa的复发揭示了HCMV UL56基因中突变C325Y的存在赋予LMV的抗性。总之，即使LMV是有效且有利的安全分子，它也可能具有较低的遗传阻隔障碍。有必要对使用LMV单疗法使用LMV单疗法作为移植受者的HCMV GCV抗性感染的救援治疗。

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