Emergence of letermovir resistance in solid organ transplant recipients with ganciclovir resistant cytomegalovirus infection: A case series and review of the literature.

Hofmann, Eveline; Sidler, Daniel; Dahdal, Suzan; Bittel, Pascal; Suter-Riniker, Franziska; Manuel, Oriol; Walti, Laura N.; Hirzel, Cédric (2021). Emergence of letermovir resistance in solid organ transplant recipients with ganciclovir resistant cytomegalovirus infection: A case series and review of the literature. Transplant infectious disease, 23(3), e13515. Wiley 10.1111/tid.13515

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Ganciclovir (GCV) resistant cytomegalovirus (CMV) infection is a common problem among solid organ transplant (SOT) recipients without prior CMV immunity (CMV D+/R-). GCV resistant CMV represents a particular challenge for CMV management. Letermovir is a recently licensed antiviral agent for primary CMV prophylaxis in allogenic hematopoietic stem cell transplant (HSCT) recipients. Given the favorable safety profile and its oral bioavailability letermovir may be considered a valuable off-label option for secondary prophylaxis of GCV resistant CMV in SOT recipients. Here, we describe our experience with letermovir as secondary prophylaxis for GCV resistant CMV in two renal transplant recipients and review the literature in regard of previously published cases. Letermovir resistance emerged after a few months of secondary prophylaxis in the two renal transplant recipients. In both cases, the previously described UL56 C325Y letermovir resistance mutation was detected. In vitro studies of letermovir suggest a relatively low genetic barrier to resistance. Therefore, caution is warranted when using letermovir as secondary prophylaxis for GCV resistant CMV infection.

Item Type:

 Journal Article (Further Contribution)

Division/Institute:

 04 Faculty of Medicine > Department of Haematology, Oncology, Infectious Diseases, Laboratory Medicine and Hospital Pharmacy (DOLS) > Clinic of Infectiology
04 Faculty of Medicine > Department of Dermatology, Urology, Rheumatology, Nephrology, Osteoporosis (DURN) > Clinic of Nephrology and Hypertension
04 Faculty of Medicine > Service Sector > Institute for Infectious Diseases

UniBE Contributor:

 Hofmann, Eveline, Sidler, Daniel (A), Dahdal, Suzan, Bittel, Pascal, Suter, Franziska Marta, Walti, Laura Naëmi, Hirzel, Cédric

Subjects:

 500 Science > 570 Life sciences; biology
600 Technology > 610 Medicine & health

ISSN:

 1398-2273

Publisher:

 Wiley

Language:

 English

Submitter:

 Annelies Luginbühl

Date Deposited:

 15 Dec 2020 09:39

Last Modified:

 29 Mar 2023 23:37

Publisher DOI:

 10.1111/tid.13515

PubMed ID:

 33210830

Uncontrolled Keywords:

 Letermovir resistance human cytomegalovirus infection (CMV) secondary CMV prophylaxis solid organ transplant

BORIS DOI:

 10.7892/boris.148390

URI:

 https://boris.unibe.ch/id/eprint/148390

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