{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T00:58:14Z","timestamp":1788224294594,"version":"build-2803163510"},"reference-count":22,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2019,9,18]],"date-time":"2019-09-18T00:00:00Z","timestamp":1568764800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Transplant Infectious Dis"],"published-print":{"date-parts":[[2019,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>The development of antiviral\u2010resistant cytomegalovirus (CMV) infection complicates the management of transplant recipients. We describe the case of a 65\u2010year\u2010old male who developed CMV disease on valganciclovir prophylaxis (donor CMV IgG positive, recipient CMV IgG indeterminate) 30\u00a0days after combined liver\u2013kidney transplantation for alcoholic cirrhosis and hepato\u2010renal syndrome. After an initial complete response to treatment dose oral valganciclovir, he developed recurrent CMV viraemia. Resistance testing revealed a UL97 mutation with in\u2010frame deletions of codons 595\u2010596. He was treated successfully with foscarnet and reduction in immunosuppression. This mutation has not been described previously and was suspected to confer ganciclovir resistance. Ganciclovir resistance occurs most commonly due to mutations in the UL97 or UL54 genes, which encode a protein kinase and a DNA polymerase, respectively. The UL97\u2010encoded protein kinase phosphorylates ganciclovir to ganciclovir triphosphate, which competitively inhibits viral replication. Mutations in the UL97 gene are typically point mutations or deletions. We describe a new mutation, del595\u2010596 in the CMV UL97 gene, occurring in the context of clinical treatment failure with standard and double\u2010dose ganciclovir, and successful virological control achieved with foscarnet. This mutation is likely to result in ganciclovir resistance, although recombinant phenotyping is required for confirmation.<\/jats:p>","DOI":"10.1111\/tid.13168","type":"journal-article","created":{"date-parts":[[2019,9,9]],"date-time":"2019-09-09T16:36:16Z","timestamp":1568046976000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Ganciclovir\u2010resistant post\u2010transplant cytomegalovirus infection due to combined deletion mutation at codons 595\u2010596 of the UL97 gene"],"prefix":"10.1111","volume":"21","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3736-0777","authenticated-orcid":false,"given":"Po Yee Mia","family":"Leung","sequence":"first","affiliation":[{"name":"Department of Nephrology Austin Health Melbourne Vic. Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas","family":"Tran","sequence":"additional","affiliation":[{"name":"Virus Identification Laboratory Victorian Infectious Diseases Reference Laboratory The Peter Doherty Institute for Infection and Immunity Melbourne Vic. Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adam","family":"Testro","sequence":"additional","affiliation":[{"name":"Liver Transplant Unit Austin Health Melbourne Vic. Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kathy","family":"Paizis","sequence":"additional","affiliation":[{"name":"Department of Nephrology Austin Health Melbourne Vic. Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jason","family":"Kwong","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases Austin Health Melbourne Vic. Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John B.","family":"Whitlam","sequence":"additional","affiliation":[{"name":"Department of Nephrology Austin Health Melbourne Vic. Australia"},{"name":"Department of Medicine University of Melbourne Melbourne Vic. Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2019,9,18]]},"reference":[{"key":"e_1_2_6_2_1","doi-asserted-by":"publisher","DOI":"10.1111\/ajt.14208"},{"key":"e_1_2_6_3_1","doi-asserted-by":"publisher","DOI":"10.1097\/TP.0000000000002191"},{"key":"e_1_2_6_4_1","doi-asserted-by":"publisher","DOI":"10.2174\/187152611797636668"},{"issue":"23","key":"e_1_2_6_5_1","first-page":"2624","article-title":"How i treat how i treat resistant cytomegalovirus infection in hematopoietic cell transplantation recipients","volume":"128","author":"El CF","year":"2017","journal-title":"Blood"},{"key":"e_1_2_6_6_1","doi-asserted-by":"publisher","DOI":"10.1128\/AAC.00375-13"},{"key":"e_1_2_6_7_1","doi-asserted-by":"publisher","DOI":"10.1086\/342385"},{"key":"e_1_2_6_8_1","doi-asserted-by":"publisher","DOI":"10.1086\/338362"},{"key":"e_1_2_6_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.antiviral.2009.10.004"},{"issue":"7","key":"e_1_2_6_10_1","first-page":"2098","article-title":"Differentiated levels of ganciclovir resistance conferred by mutations at codons 591 to 603 of the cytomegalovirus UL97 kinase","volume":"55","author":"Chou S","year":"2017","journal-title":"Gene"},{"key":"e_1_2_6_11_1","doi-asserted-by":"publisher","DOI":"10.1128\/CMR.00009-10"},{"key":"e_1_2_6_12_1","doi-asserted-by":"publisher","DOI":"10.1155\/2016\/4560745"},{"key":"e_1_2_6_13_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1706640"},{"key":"e_1_2_6_14_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1473-3099(11)70024-X"},{"key":"e_1_2_6_15_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1600-6143.2012.04231.x"},{"key":"e_1_2_6_16_1","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/ciy706"},{"key":"e_1_2_6_17_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.bbmt.2016.01.009"},{"key":"e_1_2_6_18_1","doi-asserted-by":"publisher","DOI":"10.1681\/ASN.2018010009"},{"key":"e_1_2_6_19_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcv.2016.07.015"},{"key":"e_1_2_6_20_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.antiviral.2019.01.008"},{"key":"e_1_2_6_21_1","doi-asserted-by":"publisher","DOI":"10.1097\/TP.0000000000001097"},{"key":"e_1_2_6_22_1","doi-asserted-by":"publisher","DOI":"10.1097\/00007890-198411000-00026"},{"key":"e_1_2_6_23_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12967-018-1394-x"}],"container-title":["Transplant Infectious Disease"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1111%2Ftid.13168","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/tid.13168","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/tid.13168","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/tid.13168","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,9,8]],"date-time":"2023-09-08T22:25:20Z","timestamp":1694211920000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/tid.13168"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,9,18]]},"references-count":22,"journal-issue":{"issue":"6","published-print":{"date-parts":[[2019,12]]}},"alternative-id":["10.1111\/tid.13168"],"URL":"https:\/\/doi.org\/10.1111\/tid.13168","archive":["Portico"],"relation":{},"ISSN":["1398-2273","1399-3062"],"issn-type":[{"value":"1398-2273","type":"print"},{"value":"1399-3062","type":"electronic"}],"subject":[],"published":{"date-parts":[[2019,9,18]]},"assertion":[{"value":"2019-05-13","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2019-08-25","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2019-09-18","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e13168"}}