Department of Thoracic Surgery, Institute of Development, Aging and Cancer, Tohoku University, Sendai, Miyagi, Japan.
Division of Organ Transplantation, Tohoku University Hospital, Sendai, Miyagi, Japan.
Clin Exp Med. 2024 Apr 5;24(1):68. doi: 10.1007/s10238-024-01330-2.
Letermovir, initially approved for cytomegalovirus (CMV) prophylaxis in hematopoietic stem-cell transplantation, has gained attention for off-label use in lung-transplant (LTx) recipients. Given the high susceptibility of LTx recipients to CMV infection, this study explores the effectiveness and safety of letermovir prophylaxis. A retrospective analysis of using letermovir for LTx recipients at Tohoku University Hospital (January 2000 to November 2023) was conducted. Case summaries from other Japanese transplant centers and a literature review were included. Six cases at Tohoku University Hospital and one at Kyoto University Hospital were identified. Prophylactic letermovir use showed positive outcomes in managing myelosuppression and preventing CMV replication. The literature review supported the safety of letermovir in high-risk LTx recipients. Despite limited reports, our findings suggest letermovir's potential as prophylaxis for LTx recipients intolerant to valganciclovir. Safety, especially in managing myelosuppression, positions letermovir as a promising option. However, careful consideration is important in judiciously integrating letermovir into the treatment protocol.
来特莫韦最初被批准用于造血干细胞移植中的巨细胞病毒 (CMV) 预防，因其在肺移植 (LTx) 受者中的非适应证使用而受到关注。鉴于 LTx 受者对 CMV 感染的高度易感性，本研究探讨了来特莫韦预防的有效性和安全性。对 2000 年 1 月至 2023 年 11 月在东北大学医院使用来特莫韦的 LTx 受者进行了回顾性分析。还包括了来自其他日本移植中心的病例总结和文献复习。在东北大学医院和京都大学医院分别确定了 6 例和 1 例。预防性使用来特莫韦在管理骨髓抑制和预防 CMV 复制方面显示出积极的结果。文献复习支持来特莫韦在高危 LTx 受者中的安全性。尽管报告有限，但我们的研究结果表明，来特莫韦可能作为不耐受缬更昔洛韦的 LTx 受者的预防药物。安全性，尤其是在管理骨髓抑制方面，使来特莫韦成为一种有前途的选择。然而，在谨慎地将来特莫韦纳入治疗方案时，需要仔细考虑。
