Analysis of cytomegalovirus DNA polymerase (UL54) mutations in solid organ transplant patients receiving valganciclovir or ganciclovir prophylaxis

J Med Virol. 2005 Nov;77(3):425-9. doi: 10.1002/jmv.20471.


We previously reported the absence of CMV UL97 (kinase) gene resistance mutations up to 12 months post-transplant following 100 days of valganciclovir prophylaxis, and a low incidence of resistance mutations following 100 days of oral ganciclovir prophylaxis in a prospective multicenter study in solid organ transplant recipients excluding lung transplants. Herein, we report UL54 (DNA polymerase) gene sequencing results for all patients with previous UL97 PCR-positive samples (n = 99) in our study. One UL54 resistance mutation (L545S known to confer ganciclovir and cidofovir resistance) was detected in a routine day-100 sample from an asymptomatic patient who received oral ganciclovir. Notably, this CMV UL54 mutation occurred in the absence of a UL97 mutation. Additionally, new UL54 variants were observed. Thus, emergence of CMV UL54 mutations in the absence of UL97 mutations is a rare but possible event that is not necessarily associated with detrimental clinical outcome in solid organ transplant recipients.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Antiviral Agents / pharmacology
  • Antiviral Agents / therapeutic use*
  • Chemoprevention
  • Cytomegalovirus / enzymology*
  • Cytomegalovirus / genetics
  • Cytomegalovirus Infections / prevention & control
  • Cytomegalovirus Infections / virology
  • DNA-Directed DNA Polymerase / genetics
  • DNA-Directed DNA Polymerase / metabolism*
  • Drug Resistance, Viral / genetics
  • Ganciclovir / analogs & derivatives*
  • Ganciclovir / pharmacology
  • Ganciclovir / therapeutic use*
  • Humans
  • Incidence
  • Mutation*
  • Organ Transplantation / adverse effects*
  • Sequence Analysis, DNA
  • Valganciclovir
  • Viral Proteins / genetics
  • Viral Proteins / metabolism*


  • Antiviral Agents
  • UL54 protein, Human herpesvirus 5
  • Viral Proteins
  • DNA-Directed DNA Polymerase
  • Valganciclovir
  • Ganciclovir