Ganciclovir-resistant CMV (GCV-R CMV) Infection Leads to Poor Clinical Outcomes and Economic Burden of Ganciclovir-resistant Cytomegalovirus Infection in Lung Transplant Recipients

Patel, Twisha; Imlay, Hannah; Kaul, Daniel; Stuckey, Linda; Gregg, Kevin

BACKGROUND: GCV-R CMV infection is an emerging cause of morbidity and mortality in lung transplant recipients. The purpose of this study was to evaluate the clinical and economic impact of GCV-R CMV infection in a high-risk population. METHODS: We performed a single-center, retrospective cohort study of lung transplant recipients with genotype confirmed GCV-R CMV and ganciclovir-sensitive (GCV-S) CMV infection, matched (1:3) by year of diagnosis. Clinical outcomes within 1 year following the onset of CMV infection and total hospital costs were assessed. RESULTS: Twenty-eight patients were included in the analysis: 7 with GCV-R CMV infection and 21 with GCV-S CMV infection. Baseline demographics (Table 1) were similar in the two groups. CMV load at diagnosis was numerically higher (282,932 I.U./mL [IQR, 43,181 IU/mL 3,368,931 I.U./mL] vs. 44,604 IU/mL [IQR, 6,314 I.U./mL 88,797 IU/mL], P = 0.10) and days to CMV infection following discontinuation of antiviral prophylaxis was numerically lower (20 [IQR, 0–137] vs. 175 [IQR, 123–190], P = 0.07) in the GCV-R CMV group. All-cause mortality (71.4% vs. 19.0%, P = 0.02) and total hospital days due to CMV infection (63 [IQR, 34–76] vs. 6 [IQR, 2–9], P < 0.01) were significantly higher in the GCV-R CMV cohort. There were no differences in allograft rejection and hospital readmission between the two groups. Total hospital costs were significantly higher amongst patients with GCV-R CMV infection ($208,924 [IQR, $114,555-$253,191] vs. $20,419 [IQR, $12,438-$27,892], P < 0.01). CONCLUSION: GCV-R CMV infection is associated with poor outcomes and considerable healthcare costs. Novel prophylaxis and treatment strategies are needed to combat CMV infection in lung transplant recipients. DISCLOSURES: T. Patel, Merck: Grant Investigator, Research grant. K. Gregg, Merck: Grant Investigator, Research grant