Aryal Shambhu, Katugaha Shalika B, Cochrane Adam, Brown Anne Whitney, Nathan Steven D, Shlobin Oksana A, Ahmad Kareem, Marinak Lauren, Chun Jessica, Fregoso Margaret, Desai Shashank, King Christopher
Advanced Lung Disease and Transplant Program, Inova Fairfax Hospital, Falls Church, Virginia.
Infectious Diseases Physicians, Inc., Falls Church, Virginia.
Transpl Infect Dis. 2019 Dec;21(6):e13166. doi: 10.1111/tid.13166. Epub 2019 Sep 18.
Cytomegalovirus (CMV) infection is common in thoracic organ transplant recipients. Valganciclovir and ganciclovir are used for both prophylaxis and treatment of this infection, but intolerance and treatment failure are common. Letermovir has been demonstrated to reduce the risk of CMV infection when used for prophylaxis in allogeneic hematopoietic cell transplantation. However, there are no data on its efficacy in thoracic organ transplantation.
We examined the use of letermovir for either CMV prophylaxis (primary and secondary) or treatment in heart and lung transplant recipients at our institution from February 1, 2018, through December 31, 2018.
Nine total patients received letermovir at our institution (8 lung transplant, 1 heart transplant) during the study period. Letermovir was prescribed for CMV prophylaxis in eight patients (primary prophylaxis in two patients and secondary prophylaxis in 6 patients), and for treatment of CMV DNAemia in two cases. One patient received letermovir for both secondary prophylaxis and treatment on separate occasions. Three out of 8 (37.5%) patients receiving letermovir for prophylaxis developed CMV DNAemia during prophylaxis. One patient treated for CMV disease had clinical failure with a sharp rise in serum CMV DNA PCR. The other patient treated for low-grade CMV DNAemia initially had a slight rise in CMV DNA PCR, but has since had a sustained response. No major side effects were experienced, and 2 patients reported minor side effects.
Letermovir was well tolerated with only minor side effects reported; however, the rate of development of CMV DNAemia on prophylaxis was considerable. Further study of the dosing and efficacy of letermovir for CMV prophylaxis or treatment in thoracic organ transplant recipients is warranted.
巨细胞病毒（CMV）感染在胸器官移植受者中很常见。缬更昔洛韦和更昔洛韦用于预防和治疗这种感染，但不耐受和治疗失败很常见。来特莫韦已被证明在用于异基因造血细胞移植的预防时可降低CMV感染风险。然而，尚无关于其在胸器官移植中疗效的数据。
我们研究了2018年2月1日至2018年12月31日期间在我们机构使用来特莫韦对心脏和肺移植受者进行CMV预防（一级和二级）或治疗的情况。
在研究期间，我们机构共有9名患者接受了来特莫韦治疗（8例肺移植，1例心脏移植）。8例患者使用来特莫韦进行CMV预防（2例一级预防，6例二级预防），2例用于治疗CMV血症。1例患者在不同时间分别接受来特莫韦二级预防和治疗。8例接受来特莫韦预防的患者中有3例（37.5%）在预防期间出现CMV血症。1例接受CMV疾病治疗的患者临床治疗失败，血清CMV DNA PCR急剧上升。另1例接受低级别CMV血症治疗的患者最初CMV DNA PCR略有上升，但此后有持续反应。未出现重大副作用，2例患者报告有轻微副作用。
来特莫韦耐受性良好，仅报告有轻微副作用；然而，预防期间CMV血症的发生率相当高。有必要进一步研究来特莫韦在胸器官移植受者中进行CMV预防或治疗的剂量和疗效。
