Letermovir for Prophylaxis of Cytomegalovirus After Solid Organ Transplantation: A Single-Center, Observational Study
1Massachusetts General Hospital, Boston, MA, 2UPMC, Pittsburgh, PA, 3Univ of Pittsburgh, Pittsburgh, PA, 4Univ of Pittsburgh and UPMC, Pittsburgh, PA
Meeting: 2022 American Transplant Congress
Abstract number: 1620
Keywords: Cytomeglovirus, Prophylaxis, Viral therapy
Topic: Clinical Science » Infection Disease » 24 - All Infections (Excluding Kidney & Viral Hepatitis)
Session Information
Session Name: All Infections (Excluding Kidney & Viral Hepatitis) IV
Session Type: Poster Abstract
Date: Tuesday, June 7, 2022
Session Time: 7:00pm-8:00pm
Presentation Time: 7:00pm-8:00pm
Location: Hynes Halls C & D
*Purpose: Cytomegalovirus (CMV) infections cause significant complications post-transplant; however, prophylactic medications are often limited by toxicities. Letermovir is a novel terminase inhibitor specific to CMV with a limited toxicity profile that is used off-label for CMV prophylaxis in solid organ transplant recipients (SOT). The purpose of this study was to characterize the use of letermovir in SOT at a single center.
*Methods: Adult SOT who received at least one dose of letermovir from March 1, 2018 to December 31, 2020 were included for analysis. The primary objective was to describe breakthrough CMV DNAemia in patients receiving letermovir prophylaxis, measured by polymerase chain reaction assay (PCR).
*Results: 37 SOT received letermovir (table), 24 (65%) for secondary prophylaxis, 12 (32%) for primary prophylaxis, and 1 (3%) for treatment. 19 (51%) had breakthrough CMV DNAemia while on letermovir. Letermovir was continued in 14 (74%) SOT with breakthrough CMV DNAemia and was changed to val(ganciclovir) in 5 (26%). Among breakthrough cases who continued on letermovir, val(ganciclovir) was added-on in 3 cases, and letermovir dose was increased in 1 case. Median CMV PCR for SOT with breakthrough DNAemia was 1658 IU/ml (range 214 – 27355). Most breakthrough cases occurred in secondary prophylaxis (17/19) and were CMV serostatus D+/R- (12/19). 7/19 SOT with breakthrough CMV DNAemia had known ganciclovir resistance prior to letermovir initiation. There was no clinically significant CMV disease among SOT who had breakthrough. Median white blood cell count was comparable pre (4.4 IQR 2.4-7.8) and post (5.2 IQR 3.2-7.6) letermovir initiation.
| Age, median (range) | 58 (21-71) |
| Male, n (%) | 23 (62) |
| Transplant type, n (%) | Lung, 25 (68) |
| Kidney, 5 (14) | |
| Heart, 4 (11) | |
| Liver, 1 (3) | |
| Pancreas, 1 (3) | |
| Lung/liver, 1 (3) | |
| CMV serostatus, n (%) | D+/R-, 24 (65) |
| D+/R+, 7 (19) | |
| D-/R+, 1 (3) | |
| D-/R-, 2 (5) Unknown, 3 (8) | |
| Induction, n (%) | Basiliximab, 29 (78) Thymoglobulin, 4 (11) Alemtuzumab, 3 (8) None, 1 (3) |
*Conclusions: Letermovir may be an alternative for primary CMV prophylaxis in SOT. Breakthrough CMV DNAemia is frequent in patients receiving letermovir for secondary prophylaxis.
To cite this abstract in AMA style:
Bullard TN, Moore CA, Dasigi J, Sacha LM, Iasella CA, Shimko KA, McCreary EK, Silveira FP. Letermovir for Prophylaxis of Cytomegalovirus After Solid Organ Transplantation: A Single-Center, Observational Study [abstract]. Am J Transplant. 2022; 22 (suppl 3). https://atcmeetingabstracts.com/abstract/letermovir-for-prophylaxis-of-cytomegalovirus-after-solid-organ-transplantation-a-single-center-observational-study/. Accessed November 21, 2024.« Back to 2022 American Transplant Congress