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Cytomegalovirus (CMV) mutations associated with antiviral resistance have become a major problem related to high mortality in kidney transplant patients. The aim of the study was to investigate mutations in the CMV genes UL97 and UL54 associated with antiviral resistance. A retrospective observational cohort study was carried out at Hospital Ophir Loyola (HOL), a reference in Kidney Transplantation. A total of 81 patients who underwent kidney transplantation were followed up between 2016 and 2018 were monitored for CMV viral load by performing qPCR. Sanger sequencing was performed on 66 patients. All CMV-positive kidney transplant recipients were included. Mutations were observed in 15 samples (22.72%) from patients. Most cases involved UL97 mutations. Mutation in UL54 without mutation in UL97 was detected in only 2 cases. Resistance mutations in UL97 were identified, such as M460V, L595S, H520Q, two co-mutations D465R + Del524 and A594P + D413A and a 3 codon deletion (del598-601). The search for mutations in the CMV genes identified mutations that confer resistance to conventional antivirals, such as ganciclovir and cidofovir, used in the treatment of these patients. Confirmation of the association with increased CMV viral load in transplanted patients, due to mutation in resistance genes, requires phenotypic analysis for confirmation purposes. These were the first findings in patients in northern Brazil that we know of.

Devido às incertezas sobre o impacto da síndrome respiratória aguda grave através da infecção pelo coronavírus 2 (SARS-CoV-2), a doação de órgãos de indivíduos com suspeita ou confirmação de infecção pela doença coronavírus 2019 (COVID-19) é uma contraindicação absoluta. Entretanto, essa ação causou a redução do número de transplantes renais e o aumento da mortalidade na lista de espera. Por causa disso, a possibilidade de transplante extrapulmonar de órgãos de doadores com SARS-CoV-2 positivo com doença assintomática ou leve tem sido discutida. Nesse contexto, o presente estudo teve como objetivo relatar o caso de uma receptora feminina de 40 anos de idade em hemodiálise há seis anos, que recebeu um rim de uma doadora que teve um teste de reação em cadeia de polimerase em tempo real (RT-PCR) detectável para SARS-CoV-2 dois dias após o transplante da cirurgia. Durante a hospitalização, ela não apresentava sintomas respiratórios, e todos os testes RT-PCR realizados para secreção nasofaríngea contendo SARS-CoV-2 tiveram resultados indetectáveis. Assim, após 39 dias de hospitalização e com boa evolução clínica e laboratorial, a paciente teve alta para permanecer em acompanhamento ambulatorial.

Due to uncertainties about the impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, the donation of organs from individuals with suspected or confirmed infection of coronavirus disease 2019 (COVID-19) is absolute contraindication. However, this action caused reduction in the number of kidney transplants and increase inmortality in the waitlist. Because of that, the possibility of extrapulmonaryorgan transplantation from donors with SARS-CoV 2 positive with asymptomatic or mild illness has been questioned. In this context, the present study aimed to report the case of a 40-year-old female recipient in hemodialysis six years ago, whom received a kidney from donor who had real-time polymerase chain reaction (RT-PCR) test detectable for SARS CoV-2 after two days of the surgery transplantation. During hospitalization, she had no respiratory symptoms, and all RT-PCR tests for SARS-CoV-2 nasopharyngeal secretion performed had undetectable results. Thus, after 39 days of hospitalization and with good clinical and laboratory evolution, the patient was discharged toremain in outpatient follow-up.