Epidemiology and Outcome of Ganciclovir-Resistant Cytomegalovirus Infection After Solid Organ Transplantation: A Single Transplant Center Experience in Thailand J. Bruminhent*, P. Rotjanapan, and S.P. Watcharananan Division of Infectious Diseases, Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand ABSTRACT Background. Data on drug-resistant cytomegalovirus (CMV) infection in solid organ transplantation (SOT) are not often reported from resource-limited settings. We aimed to investigate the epidemiology and outcomes of this infection in SOT recipients at our institution. Methods. This was a retrospective study conducted from January 2012 to May 2015. We included all SOT recipients who were suspected for drug-resistant CMV infection. Genotypic assay for UL97 gene mutation was analyzed by real-time polymerase chain reaction. Patients were reviewed for demographic data, clinical presentation, virologic data, treatment, and outcomes. Results. The population consisted of 18 (12 kidney, 6 liver) SOT recipients with a median age of 20 years (interquartile range [IQR], 1e49); 44% were male. Anti-CMV resistance testing was analyzed at a median time of 23 days (IQR, 14e33) after initiation of anti- CMV therapy with a median CMV load of log 3.79 copies/mL (IQR, 3.37e4.58). During a median period of 2 years (IQR, 1e3), 6 SOT recipients were identified with UL97 gene mutation in codon 460, conferring ganciclovir (GCV) resistance. Patients with UL97 gene mutation had a longer mean duration of CMV DNAemia compared with those without mutation (263 vs 107 days; P ¼ .04). All patients received high-dose GCV. Two patients received foscarnet and cidofovir. Two patients died (noneCMV-related), and 4 patients. Conclusions. GCV-resistant CMV infection in SOT recipients is an emerging clinical problem in resource-limited country. Those with UL97 mutation CMV infection have prolonged duration of CMV DNAemia. Clinicians should be aware of this condition when caring for SOT recipients. C YTOMEGALOVIRUS (CMV) is a common pathogen causing infection after solid organ transplantation (SOT). CMV infection causes significant morbidity and sometimes mortality in SOT recipients [1]. Our previous study reported a greater risk of graft failure and death in kidney transplant recipients who had development of CMV infection after transplant [2]. Even with pre-existing CMV immunity in the majority of Thai kidney transplant re- cipients, they remain at risk of CMV reactivation, especially those with profound immunosuppression by use of anti- thymocyte globulin (ATG) therapy [2,3]. Ganciclovir (GCV) remains a drug of choice for treatment of CMV infection; however, an increase of drug-resistant CMV infection has been reported recently [4]. CMV resistance most commonly occurs after prolonged exposure to *Address correspondence to Jackrapong Bruminhent, Division of Infectious Diseases, Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, 270 Rama VI Road, Phaya Thai, Bangkok 10400, Thailand. E-mail: jbruminhent@gmail.com 0041-1345/17 http://dx.doi.org/10.1016/j.transproceed.2017.03.053 ª 2017 Elsevier Inc. All rights reserved. 230 Park Avenue, New York, NY 10169 1048 Transplantation Proceedings, 49, 1048e1052 (2017)