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Case report: Brincidofovir-induced reversible severe acute kidney injury in 2 solid-organ transplant for treatment of cytomegalovirus infection.

ABSTRACT: RATIONALE:Resistant cytomegalovirus-mediated infections are increasing in solid organ recipient with few available alternative treatments. Brincidofovir is an oral broad-spectrum antiviral in development for prevention and treatment of viral infection, particularly cytomegalovirus. PATIENTS CONCERNS:Although brincidofovir is an analogue of cidofovir, previous studies reported no renal toxicity. DIAGNOSES:Here, we report 2 cases of severe tubular necrosis in solid organ recipients, 1 heart and 1 kidney transplant. INTERVENTIONS:Both patients received brincidofovir for the treatment of cytomegalovirus infection with mutation of UL-97. They presented an acute kidney injury without any occurrence of other clinical event such as introduction of nephrotoxic drug, graft rejection, urinary tract obstruction or infection, and calcineurin inhibitor overdosage. In each case, renal biopsy showed extended tubular necrosis. OUTCOMES:The discontinuation of brincidofovir led to improve renal function without other any intervention. Reintroduction of brincidofovir in case 1, due to the absence of other medical alternative, led to a new episode of acute kidney injury. One more time, renal biopsy showed tubular necrosis and patient recovered renal function after discontinuation. LESSONS:To our knowledge, this is the first report of brincidofovir-mediated renal adverse event. Clinicians may be aware of this severe complication in this specific population.

SUBMITTER: Faure E

PROVIDER: S-EPMC5591119 | biostudies-literature | 2016 Nov

REPOSITORIES: biostudies-literature

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Case report: Brincidofovir-induced reversible severe acute kidney injury in 2 solid-organ transplant for treatment of cytomegalovirus infection.

Faure Emmanuel E Galperine Tatiana T Cannesson Olivier O Alain Sophie S Gnemmi Viviane V Goeminne Celine C Dewilde Annie A Béné Johana J Lasri Mohamed M Lessore de Sainte Foy Célia C Lionet Arnaud A

Medicine 20161101 44

<h4>Rationale</h4>Resistant cytomegalovirus-mediated infections are increasing in solid organ recipient with few available alternative treatments. Brincidofovir is an oral broad-spectrum antiviral in development for prevention and treatment of viral infection, particularly cytomegalovirus.<h4>Patients concerns</h4>Although brincidofovir is an analogue of cidofovir, previous studies reported no renal toxicity.<h4>Diagnoses</h4>Here, we report 2 cases of severe tubular necrosis in solid organ reci ...[more]

PMID: 27858871

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Project description:BackgroundCytomegalovirus (CMV) is among the most common viral infections after solid organ transplantation (SOT). Associations of CMV with cancer risk among SOT recipients have been incompletely evaluated.MethodsThe authors used linked data from the US SOT registry and 32 cancer registries. Poisson regression was used to compare cancer incidence across CMV risk groups based on donor (D) and recipient (R) immunoglobulin G (IgG) serostatus: high risk (R-negative/D-positive), moderate risk (R-positive), and low risk (R-negative/D-negative).ResultsIn total, 247,318 SOT recipients were evaluated during 2000-2017 (R-negative/D-positive, 20.3%; R-positive, 62.9%; R-negative/D-negative, 16.8%). CMV-seropositive recipients were older, more racially/ethnically diverse, and had lower socioeconomic status than CMV-seronegative recipients. Compared with R-negative/D-negative recipients, recipients in the R-negative/D-positive and R-positive groups had a lower incidence of diffuse large B-cell lymphoma (DLBCL; R-negative/D-positive: adjusted incidence rate ratio [aIRR], 0.74; 95% confidence interval [CI], 0.59-0.91; R-positive: aIRR, 0.83; 95% CI, 0.69-1.00). CMV serostatus modified the association between Epstein-Barr virus (EBV) status and DLBCL (p = .0006): DLBCL incidence was increased for EBV R-negative/D-positive recipients (aIRR, 3.46; 95% CI, 1.50-7.95) among CMV R-negative/D-negative recipients but not among the other CMV risk groups. Compared with recipients who were CMV R-negative/D-negative, those who were R-negative/D-positive had a lower incidence of small intestine cancer (aIRR, 0.23; 95% CI, 0.09-0.63), and R-positive recipients had a higher incidence of lung cancer (aIRR, 1.24; 95% CI, 1.05-1.46). CMV status was not associated with risk for other cancers.ConclusionsCMV status was not associated with risk for most cancers among SOT recipients. The inverse association with DLBCL may reflect the protective effects of CMV prophylaxis or treatment with off-target efficacy against EBV infection (the major cause of lymphoma in SOT recipients).

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Case report: Brincidofovir-induced reversible severe acute kidney injury in 2 solid-organ transplant for treatment of cytomegalovirus infection.

Publications

Case report: Brincidofovir-induced reversible severe acute kidney injury in 2 solid-organ transplant for treatment of cytomegalovirus infection.

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