Lung Transplant Recipients with Cystic Fibrosis Commonly Resistant to Ganciclovir

Cystic fibrosis patients frequently infected with strains of life-threatening virus.

Although ganciclovir (GCV) is given to lung transplant recipients to fight off a common pathogen called cytomegalovirus (CMV), those with cystic fibrosis (CF) are more frequently infected with strains of the life-threatening virus that are resistant to the antiviral drug.

In examining GCV as a treatment for CMV infection following lung transplantation, researchers from the Loyola University Medical Center determined that the drug significantly reduces mortality among patients, from a rate of 34% to approximately 3%. However, the investigators also found that between 5% and 10% of lung transplant recipients are infected with antibiotic-resistant strains.

While reviewing the medical records of 51 lung transplant patients, the research team discovered that 21 had CMV infection, and 10 of those patients responded well to GCV. Of the remaining 11 patients, 6 had sufficient levels of GCV in their bloodstreams and experienced a delayed yet adequate response to the drug.

All 5 patients who had insufficient levels of GCV and did not respond to the drug were infected with antibiotic-resistant strains of the CMV virus, the investigators found.

“In our lung transplant recipient cohort, GCV levels were subtherapeutic in all patients with persistent suboptimal response to GCV, each of whom had…CMV infection,” the study authors wrote. “In contrast, GCV levels were therapeutic in CMV-infected patients with delayed GCV response.”

Furthermore, 4 of the 5 patients who did not respond to GCV treatment had CF. In contrast, just 2 of the 16 patients who responded to GCV had CF.

Thus, the researchers concluded that those with CF who require lung transplantation must be monitored to ensure that GCV is working effectively within their bodies, as CF patients lack the enzymes necessary for the absorption of food and medicine.