Safety and efficacy of foscarnet for the management of ganciclovir-resistant or refractory cytomegalovirus infections: A single-center study

Brett Pierce, Chad L. Richardson, Lisa Lacloche, Anne Allen, Michael G Ison*

*Corresponding author for this work

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

Background: Infection with cytomegalovirus (CMV) is an important cause of morbidity and mortality following solid organ transplantation. Resistance to ganciclovir can rarely develop via mutations in UL97 or UL54. There are limited published studies assessing the safety and efficacy of foscarnet for the management of ganciclovir-resistant or refractory cytomegalovirus infection and many centers are reluctant to utilize this important therapy because of concerns about toxicity. Methods: Solid organ recipients transplanted between January 1, 2006 and December 31, 2014 who received at least 1 dose of foscarnet were retrospectively reviewed to assess treatment outcomes, tolerability, and safety of foscarnet. Results: Ten of 31 (32.3%) patients who received foscarnet during the study period died during treatment with foscarnet, whereas all 21 surviving recipients successfully cleared infection. Of these surviving patients, 3 (14.3%) developed significant renal dysfunction, defined as >25% decline in estimated glomerular filtration rate during treatment; one-third had definitive renal biopsy results consistent with foscarnet-induced toxicity. Conclusion: Although mortality was high in this population, foscarnet use, with proper precautions, was generally safe and significant renal dysfunction was lower than previously reported in other sources, even with extended use.

Original languageEnglish (US)
Article numbere12852
JournalTransplant Infectious Disease
Volume20
Issue number2
DOIs
StatePublished - Apr 1 2018

Fingerprint

Foscarnet
Ganciclovir
Cytomegalovirus Infections
Safety
Kidney
Mortality
Organ Transplantation
Glomerular Filtration Rate
Therapeutics
Morbidity
Biopsy
Mutation
Infection

Keywords

  • cytomegalovirus
  • foscarnet
  • ganciclovir
  • resistance
  • transplant

ASJC Scopus subject areas

  • Transplantation
  • Infectious Diseases

Cite this

@article{49f734cf68f74a33badd2b092e3c21d5,
title = "Safety and efficacy of foscarnet for the management of ganciclovir-resistant or refractory cytomegalovirus infections: A single-center study",
abstract = "Background: Infection with cytomegalovirus (CMV) is an important cause of morbidity and mortality following solid organ transplantation. Resistance to ganciclovir can rarely develop via mutations in UL97 or UL54. There are limited published studies assessing the safety and efficacy of foscarnet for the management of ganciclovir-resistant or refractory cytomegalovirus infection and many centers are reluctant to utilize this important therapy because of concerns about toxicity. Methods: Solid organ recipients transplanted between January 1, 2006 and December 31, 2014 who received at least 1 dose of foscarnet were retrospectively reviewed to assess treatment outcomes, tolerability, and safety of foscarnet. Results: Ten of 31 (32.3{\%}) patients who received foscarnet during the study period died during treatment with foscarnet, whereas all 21 surviving recipients successfully cleared infection. Of these surviving patients, 3 (14.3{\%}) developed significant renal dysfunction, defined as >25{\%} decline in estimated glomerular filtration rate during treatment; one-third had definitive renal biopsy results consistent with foscarnet-induced toxicity. Conclusion: Although mortality was high in this population, foscarnet use, with proper precautions, was generally safe and significant renal dysfunction was lower than previously reported in other sources, even with extended use.",
keywords = "cytomegalovirus, foscarnet, ganciclovir, resistance, transplant",
author = "Brett Pierce and Richardson, {Chad L.} and Lisa Lacloche and Anne Allen and Ison, {Michael G}",
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Safety and efficacy of foscarnet for the management of ganciclovir-resistant or refractory cytomegalovirus infections : A single-center study. / Pierce, Brett; Richardson, Chad L.; Lacloche, Lisa; Allen, Anne; Ison, Michael G.

In: Transplant Infectious Disease, Vol. 20, No. 2, e12852, 01.04.2018.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Safety and efficacy of foscarnet for the management of ganciclovir-resistant or refractory cytomegalovirus infections

T2 - A single-center study

AU - Pierce, Brett

AU - Richardson, Chad L.

AU - Lacloche, Lisa

AU - Allen, Anne

AU - Ison, Michael G

PY - 2018/4/1

Y1 - 2018/4/1

N2 - Background: Infection with cytomegalovirus (CMV) is an important cause of morbidity and mortality following solid organ transplantation. Resistance to ganciclovir can rarely develop via mutations in UL97 or UL54. There are limited published studies assessing the safety and efficacy of foscarnet for the management of ganciclovir-resistant or refractory cytomegalovirus infection and many centers are reluctant to utilize this important therapy because of concerns about toxicity. Methods: Solid organ recipients transplanted between January 1, 2006 and December 31, 2014 who received at least 1 dose of foscarnet were retrospectively reviewed to assess treatment outcomes, tolerability, and safety of foscarnet. Results: Ten of 31 (32.3%) patients who received foscarnet during the study period died during treatment with foscarnet, whereas all 21 surviving recipients successfully cleared infection. Of these surviving patients, 3 (14.3%) developed significant renal dysfunction, defined as >25% decline in estimated glomerular filtration rate during treatment; one-third had definitive renal biopsy results consistent with foscarnet-induced toxicity. Conclusion: Although mortality was high in this population, foscarnet use, with proper precautions, was generally safe and significant renal dysfunction was lower than previously reported in other sources, even with extended use.

AB - Background: Infection with cytomegalovirus (CMV) is an important cause of morbidity and mortality following solid organ transplantation. Resistance to ganciclovir can rarely develop via mutations in UL97 or UL54. There are limited published studies assessing the safety and efficacy of foscarnet for the management of ganciclovir-resistant or refractory cytomegalovirus infection and many centers are reluctant to utilize this important therapy because of concerns about toxicity. Methods: Solid organ recipients transplanted between January 1, 2006 and December 31, 2014 who received at least 1 dose of foscarnet were retrospectively reviewed to assess treatment outcomes, tolerability, and safety of foscarnet. Results: Ten of 31 (32.3%) patients who received foscarnet during the study period died during treatment with foscarnet, whereas all 21 surviving recipients successfully cleared infection. Of these surviving patients, 3 (14.3%) developed significant renal dysfunction, defined as >25% decline in estimated glomerular filtration rate during treatment; one-third had definitive renal biopsy results consistent with foscarnet-induced toxicity. Conclusion: Although mortality was high in this population, foscarnet use, with proper precautions, was generally safe and significant renal dysfunction was lower than previously reported in other sources, even with extended use.

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