Suppression of CMV Infection with Letermovir in a Kidney Transplant Patient
  • Uta Köpf
    Department of Internal Medicine I, Faculty of Medicine, University Bonn, Bonn, Germany
  • Hans Ulrich Klehr
    KfH Kuratorium für Heimdialyse und Nierentransplantation e.V., Bonn, Germany
  • Anna-Maria Eis-Huebinger
    Institute of Virology, Faculty of Medicine, University Bonn, Bonn, Germany
  • Souhaib Aldabbagh
    Institute of Virology, Faculty of Medicine, University Bonn, Bonn, Germany
  • Christian Strassburg
    KfH Kuratorium für Heimdialyse und Nierentransplantation e.V., Bonn, Germany
  • Dominik Boes
    Department of Internal Medicine I, Faculty of Medicine, University Bonn, Bonn, Germany; KfH Kuratorium für Heimdialyse und Nierentransplantation e.V., Bonn, Germany
  • Philipp Lutz
    Department of Internal Medicine I, Faculty of Medicine, University Bonn, Bonn, Germany

Keywords

Cytomegalovirus,, kidney transplantation, UL97 mutation, antiviral resistance, letermovir

Abstract

Infection with cytomegalovirus (CMV) with resistance to ganciclovir (GCV) is a therapeutic challenge in kidney transplant patients, because standard treatment options are nephrotoxic. We report the case of a kidney transplant recipient with GCV-resistant CMV disease, in whom letermovir, a novel inhibitor of CMV packaging, was administered off-label and prevented a relapse of disease once the CMV load was decreased by cidofovir. Furthermore, we observed significant drug interactions between letermovir and tacrolimus.

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References

  • Kotton CN, Kumar D, Caliendo AM, Huprikar S, Chou S, Danziger-Isakov L, et al. The third international consensus guidelines on the management of cytomegalovirus in solid-organ transplantation. Transplantation 2018;102(6):900–931.

  • Frietsch JJ, Michel D, Stamminger T, Hunstig F, Birndt S, Schnetzke U, et al. In vivo emergence of UL56 C325Y cytomegalovirus resistance to letermovir in a patient with acute myeloid leukemia after hematopoietic cell transplantation. Mediterr J Hematol Infect Dis 2019;11(1):1–4.

  • Ligat G, Cazal R, Hantz S, Alain S. The human cytomegalovirus terminase complex as an antiviral target: a close-up view. FEMS Microbiol Rev 2018;42(2):137–145.

  • Veit T, Munker D, Kauke T, Zoller M, Michel S, Ceelen F, et al. Letermovir for difficult to treat cytomegalovirus infection in lung transplant recipients. Transplantation 2020;104(2):410–414.

  • Aryal S, Katugaha SB, Cochrane A, Brown AW, Nathan SD, Shlobin OA, et al. Single-center experience with use of letermovir for CMV prophylaxis or treatment in thoracic organ transplant recipients. Transpl Infect Dis 2019;21(6):e13166.

  • Turner N, Strand A, Grewal DS, Cox G, Arif S, Baker AW, et al. Use of letermovir as salvage therapy for drug-resistant cytomegalovirus retinitis. Antimicrob Agents Chemother 2019;63(3):390.

  • Jung S, Michel M, Stamminger T, Michel D. Fast breakthrough of resistant cytomegalovirus during secondary letermovir prophylaxis in a hematopoietic stem cell transplant recipient. BMC Infect Dis 2019;19(1):388.

  • Kropeit D, von Richter O, Stobernack H-P, Rübsamen-Schaeff H, Zimmermann H. Pharmacokinetics and safety of letermovir coadministered with cyclosporine A or tacrolimus in healthy subjects. Clin Pharmacol Drug Dev 2017;7(1):9–21.

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    Published: 2020-04-20
    Issue: 2020: Vol 7 No 7 (view)

    How to cite:
    1.
    Köpf U, Klehr HU, Eis-Huebinger A-M, Aldabbagh S, Strassburg C, Boes D, Lutz P. Suppression of CMV Infection with Letermovir in a Kidney Transplant Patient. EJCRIM 2020;7 doi:10.12890/2020_001622.