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Negative antigenaemia was detected on the tenth day of this approach. The patient completed 3 weeks of therapy with no side-effects and was discharged with a serum creatinine of 1.1 mg/dL, maintaining the use of everolimus (1.5 mg twice daily) and PDN (10 mg once daily) as immunosuppressive agents. The patient's graft function remains stable with no relapse of viral replication after 55 months of follow-up. Discussion The cases reported here are two examples of the issues raised by CMV resistance in renal transplant recipients, namely the relation to VGCV exposure and the difficulties of treatment and eradication. Our first patient was a low-risk recipient for CMV infection, not only due to the donor�Crecipient CMV serostatus but also because he was a non-lung transplant recipient and did not receive lymphocyte-depleting antibody as an immunosuppressant [1]. For this reason, we used a pre-emptive approach, [http://www.selleckchem.com/products/pifithrin-alpha.html Pifithrin-��] as has been suggested by many authors, with weekly monitoring of viraemia for 12 weeks after transplant and initiation of treatment when viraemia reaches a [http://www.selleckchem.com/screening/pfizer-licensed-library.html Pfizer Licensed Compound Library molecular weight] specified threshold [1]. However, our patient presented with clinical disease before the detection of a viral load, as frequently happens in invasive gastrointestinal CMV disease. Our second case was a high-risk patient for CMV infection due to exposure to lymphocyte-depleting antibodies. A decision was therefore made to use antiviral prophylaxis for a 3- to 6-month period beginning soon after transplant [1]. Nevertheless, our patient developed CMV infection during prophylaxis and was presumed to have a resistant strain. In fact, CMV drug resistance has been observed with both strategies (prophylaxis and pre-emptive treatment), and there are contradictory data regarding which is associated with a higher risk [11, 12]. Screening for CMV IgG in donors and recipients should be performed before transplant to allow for risk stratification and to guide the posterior approach. If the result is negative and a significant amount of time elapses after testing, serology should be repeated at the time of transplantation. Serological testing only reveals prior exposure, and it is not useful [http://en.wikipedia.org/wiki/Temsirolimus Temsirolimus (CCI-779, NSC 683864)] either for diagnosis of active disease or to provide guidance on the therapeutic response. CMV infection can be detected by testing for antigenaemia or DNAaemia (by PCR analysis). These are good methods for diagnosis and treatment monitoring, but each has its limitations. The antigenaemia assay is a rapid semi-quantitative immunofluorescence test that detects phosphoprotein 65 (pp65), produced in CMV-infected polymorphonuclear leukocytes in peripheral blood [13, 14]. It has good sensitivity and high specificity, but cannot be performed when the neutrophil count is