Remdesivir resistance in transplant recipients with persistent COVID-19 (preprint)

The medical community currently lacks robust data regarding the incidence, prevalence, and clinical significance of mutations associated with resistance to severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) therapeutics.  This report describes two renal transplant recipients who, after remdesivir exposure, developed a de novo V792I RNA-dependent RNA polymerase (RdRp) mutation that has recently been found to confer resistance to remdesivir in vitro.  To the best of our knowledge, this publication is the first to document the emergence of V792I in patients treated with remdesivir.  Our work underscores the critical need for augmented efforts to identify concerning mutations and address their clinical implications.