| Institution: | 1. Department of Internal Medicine V, University Hospital, LMU, Comprehensive Pneumology Center (CPC-M), Member of the German Center for Lung Research (DZL), Munich, Germany;2. Laboratory for Immunogenetics, University of Munich, LMU, Munich, Germany
Department of Thoracic Surgery, University of Munich, LMU, Munich, Germany;3. Transplant Center, University of Munich, LMU, Munich, Germany;4. Clinic of Cardiac Surgery, University of Munich, LMU, Member of the German Center for Lung Research (DZL), Munich, Germany;5. Department of Anaesthesiology, University of Munich, LMU, Munich, Germany;6. Max von Pettenkofer Institute and Gene Center, Virology, German Center for Infection Research, Partner Site Munich, National Reference Center for Retroviruses, LMU, Munich, Germany |
| Abstract: | Letermovir is a new antiviral drug approved for the prophylaxis of CMV infection in allogeneic stem cell transplants. The aim of the study was to assess the therapeutic efficacy of letermovir in difficult to treat CMV infections in lung transplant recipients. All lung transplant recipients between March 2018 and August 2020, who have been treated with letermovir for ganciclovir-resistant or refractory CMV infection were included in the study and analysed retrospectively. In total, 28 patients were identified. CMV disease was present in 15 patients (53.6%). In 23 patients (82.1%), rapid response was noticed, and CMV-viral load could be significantly decreased (>1 log10) after a median of 17 14–27] days and cleared subsequently in all of these patients. Five patients (17.9%) were classified as non-responder. Thereof, development of a mutation of the CMV UL56 terminase (UL-56-Gen: C325Y) conferring letermovir resistance could be observed in three patients (60%). Common side effects were mild and mostly of gastrointestinal nature. Mild adjustments of the immunosuppressive drugs were mandatory upon treatment initiation with letermovir. In addition to other interventions, letermovir was effective in difficult to treat CMV infections in lung transplant recipients. However, in patients with treatment failure mutation conferring letermovir, resistance should be taken into account. |
