{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,20]],"date-time":"2026-10-20T00:50:01Z","timestamp":1792457401182,"version":"4.5.0"},"reference-count":21,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2026,4,29]],"date-time":"2026-04-29T00:00:00Z","timestamp":1777420800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,4,29]],"date-time":"2026-04-29T00:00:00Z","timestamp":1777420800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Clinical Transplantation"],"published-print":{"date-parts":[[2026,5]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Cytomegalovirus (CMV) infection remains one of the most prevalent and consequential post solid organ transplant (SOT) infections. Treatment is often challenging, especially when dealing with refractory and resistant CMV infections.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We performed a retrospective multicenter cohort study of SOT recipients with clinically significant CMV infection (csCMVi) during 2010\u20132016. The primary outcome was early refractory CMV infection and secondary outcomes were drug resistance, CMV recurrence, and mortality. Analysis was done with Kaplan\u2010Meier, univariable logistic regression analysis, and multivariable Cox regression.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      We included 145 SOT recipients with csCMVi, majority were liver transplant (49%). Most common induction was an anti\u2010IL\u20102 antibody (43.9%). The majority (\n                      <jats:italic>n<\/jats:italic>\n                      = 82; 56.5%) were CMV D+\/R\u2010 mismatch and presented asymptomatic infection (50.3%). After the initial 3 weeks of antiviral therapy, 13 (8.9%) patients had probable refractory csCMVi; most of them (10 [76.9%]) were CMV D+\/R\u2010 mismatch. Longer time after transplant had lower risk (OR 0.68; CI 0.48\u20130.95,\n                      <jats:italic>p<\/jats:italic>\n                      = 0.029) while lower absolute lymphocyte count (ALC) had a higher risk of early refractory csCMVi (OR 1.54; CI 1.01\u20132.44,\n                      <jats:italic>p<\/jats:italic>\n                      = 0.048). Drug\u2010resistant csCMVi occurred in 7 patients (4.8%); a high initial CMV DNA level was associated with resistant csCMVi (OR 2.00; CI 1.08\u20133.93,\n                      <jats:italic>p<\/jats:italic>\n                      = 0.031). 25 patients (17.2%) experienced recurrent csCMVi within 6 months. 30 patients (20.7%) died; refractory, resistant or recurrent CMV infections were not associated with mortality.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Refractory csCMVi is associated with a low ALC and an earlier onset after transplant. Resistant csCMVi is associated with high initial CMV DNA levels. Recurrence of csCMVi is common and potentially associated with low ALC at the end of antiviral treatment.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/ctr.70552","type":"journal-article","created":{"date-parts":[[2026,4,29]],"date-time":"2026-04-29T15:11:50Z","timestamp":1777475510000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Refractory, Resistant and Recurrent Cytomegalovirus Infections in Solid Organ Transplant Recipients: Risk Factors and Clinical Outcomes"],"prefix":"10.1111","volume":"40","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4329-4515","authenticated-orcid":false,"given":"Bismarck Steven","family":"Bisono\u2010Garcia","sequence":"first","affiliation":[{"name":"Division of Public Health, Infectious Diseases, and Occupational Medicine Mayo Clinic  Rochester Minnesota USA"},{"name":"Division of Hospital Internal Medicine Mayo Clinic  Rochester Minnesota USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2348-1017","authenticated-orcid":false,"given":"Christopher Anh\u2010Thao","family":"Dinh","sequence":"additional","affiliation":[{"name":"Division of Hospital Internal Medicine Mayo Clinic  Rochester Minnesota USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-8702-1397","authenticated-orcid":false,"given":"Benjo","family":"Ato","sequence":"additional","affiliation":[{"name":"University of the Philippines and the Philippine General Hospital  Manila Philippines"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-7248-9222","authenticated-orcid":false,"given":"Vaisak O","family":"Nair","sequence":"additional","affiliation":[{"name":"Division of Public Health, Infectious Diseases, and Occupational Medicine Mayo Clinic  Rochester Minnesota USA"},{"name":"ID Care  Hillsborough New Jersey USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2098-2868","authenticated-orcid":false,"given":"Zachary A.","family":"Yetmar","sequence":"additional","affiliation":[{"name":"Division of Public Health, Infectious Diseases, and Occupational Medicine Mayo Clinic  Rochester Minnesota USA"},{"name":"Department of Infectious Disease Cleveland Clinic Foundation  Cleveland Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5248-0227","authenticated-orcid":false,"given":"Raymund R.","family":"Razonable","sequence":"additional","affiliation":[{"name":"Division of Public Health, Infectious Diseases, and Occupational Medicine Mayo Clinic  Rochester Minnesota 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