High-dose Valganciclovir Treatment for Resistant Cytomegalovirus Colitis due to UL97 and UL54 Mutations

Baradhi, Krishna M.; Aure, R.L.; El-Amm, Jose M.

doi:10.1016/j.transproceed.2017.11.013

Cited by 9 publications

(7 citation statements)

References 7 publications

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“…In the same interest, the sensitivity of CMV to antiviral drugs has been poorly studied in biopsy specimens, and only in transplant patients [ 95 ], the techniques of sequencing being less sensitive than qPCR.…”

Section: Controversial Role Of CMV Infection In Ibd Inflammatory Fmentioning

confidence: 99%

Cytomegalovirus and Inflammatory Bowel Diseases (IBD) with a Special Focus on the Link with Ulcerative Colitis (UC)

et al. 2020

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Cytomegalovirus (CMV) infects approximately 40% of adults in France and persists lifelong as a latent agent in different organs, including gut. A close relationship is observed between inflammation that favors viral expression and viral replication that exacerbates inflammation. In this context, CMV colitis may impact the prognosis of patients suffering from inflammatory bowel diseases (IBDs), and notably those with ulcerative colitis (UC). In UC, the mucosal inflammation and T helper cell (TH) 2 cytokines, together with immunomodulatory drugs used for controlling flare-ups, favor viral reactivation within the gut, which, in turn, increases mucosal inflammation, impairs corticoid and immunosuppressor efficacy (the probability of steroid resistance is multiplied by more than 20 in the case of CMV colitis), and enhances the risk for colectomy. This review emphasizes the virological tools that are recommended for exploring CMV colitis during inflammatory bowel diseases (IBD) and underlines the interest of using ganciclovir for treating flare-ups associated to CMV colitis in UC patients.

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Section: Controversial Role Of CMV Infection In Ibd Inflammatory Fmentioning

confidence: 99%

Cytomegalovirus and Inflammatory Bowel Diseases (IBD) with a Special Focus on the Link with Ulcerative Colitis (UC)

et al. 2020

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“…ganciclovir (5 mg/kg BID) for a period of 10-14 d until resolution of symptoms, followed by oral valganciclovir (900 mg once a day) for 3-6 mo. High-dose valganciclovir (up to 1800 mg twice a day) and/or foscarnet and cidofovir along with immunosuppression reduction may be a treatment option for CMV colitis with ganciclovir resistance[ 76 ].…”

Section: Clinical and Histological Featuresmentioning

confidence: 99%

Gastrointestinal complications after kidney transplantation

Gioco

Corona

Ekser

et al. 2020

WJG

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Gastrointestinal complications are common after renal transplantation, and they have a wide clinical spectrum, varying from diarrhoea to post-transplant inflammatory bowel disease (IBD). Chronic immunosuppression may increase the risk of post-transplant infection and medication-related injury and may also be responsible for IBD in kidney transplant re-cipients despite immunosuppression. Differentiating the various forms of post-transplant colitis is challenging, since most have similar clinical and histological features. Drug-related colitis are the most frequently encountered colitis after kidney transplantation, particularly those related to the chronic use of mycophenolate mofetil, while de novo IBDs are quite rare. This review will explore colitis after kidney transplantation, with a particular focus on different clinical and histological features, attempting to clearly identify the right treatment, thereby improving the final outcome of patients.

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“…Overall, details on hCMV-specific anti-viral therapy were reported in 139/311 (44.7%) cases. According to the information collected, 112 patients were administered ganciclovir monotherapy, 27,83 six valganciclovir monotherapy, 25,29,31,50 and 18 a sequential combination of both drugs. 23,24,30,36,41,44,45,51,59,60,62,63,66,74 Three KTRs did not receive anti-viral therapy.…”

Section: Hcmv-gid Treatment and Outcomesmentioning

confidence: 99%

Human cytomegalovirus‐related gastrointestinal disease after kidney transplantation: A systematic review

Zais,

Sirotti,

Iesari

et al. 2023

Clinical Transplantation

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BackgroundHuman‐cytomegalovirus (hCMV) infection involving the gastrointestinal tract represents a leading cause of morbidity and mortality among kidney transplant (KT) recipients (KTRs). Signs and symptoms of the disease are extremely variable. Prompt anti‐viral therapy administration and immunosuppression modification are key factors for optimizing management. However, complex work‐up strategies are generally required to confirm the preliminary diagnosis. Unfortunately, solid evidence and guidelines on this specific topic are not available.We consequently aimed to summarize current knowledge on post‐KT hCMV‐related gastrointestinal disease (hCMV‐GID).MethodsWe conducted a systematic review (PROSPERO ID: CRD42023399363) about hCMV‐GID in KTRs.ResultsOur systematic review includes 52 case‐reports and ten case‐series, published between 1985 and 2022, collectively reporting 311 cases. The most frequently reported signs and symptoms of hCMV‐GID were abdominal pain, diarrhea, epigastric pain, vomiting, fever, and GI bleeding. Esophagogastroduodenoscopy and colonoscopy were the primary diagnostic techniques. In most cases, the preliminary diagnosis was confirmed by histology. Information on anti‐viral prophylaxis were extremely limited as much as data on induction or maintenance immunosuppression. Treatment included ganciclovir and/or valganciclovir administration. Immunosuppression modification mainly consisted of mycophenolate mofetil or calcineurin inhibitor minimization and withdrawal. In total, 21 deaths were recorded. Renal allograft‐related outcomes were described for 26 patients only. Specifically, reported events were acute kidney injury (n = 17), transplant failure (n = 5), allograft rejection (n = 4), and irreversible allograft dysfunction (n = 3).ConclusionsThe development of local and national registries is strongly recommended to improve our understanding of hCMV‐GID. Future clinical guidelines should consider the implementation of dedicated diagnostic and treatment strategies.

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High-dose Valganciclovir Treatment for Resistant Cytomegalovirus Colitis due to UL97 and UL54 Mutations

Cited by 9 publications

References 7 publications

Cytomegalovirus and Inflammatory Bowel Diseases (IBD) with a Special Focus on the Link with Ulcerative Colitis (UC)

Cytomegalovirus and Inflammatory Bowel Diseases (IBD) with a Special Focus on the Link with Ulcerative Colitis (UC)

Gastrointestinal complications after kidney transplantation

Human cytomegalovirus‐related gastrointestinal disease after kidney transplantation: A systematic review

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