Pneumologie 2020; 74(S 01): 140
DOI: 10.1055/s-0039-3403384
Posterbegehung (PO26) – Sektion Klinische Pneumologie
Die spannende Welt der Pneumologie – Kasuistiken II & mehr
Georg Thieme Verlag KG Stuttgart · New York

Letermovir for difficult to treat cytomegalovirus infection in lung transplant recipients

T Veit
1   Medizinische Klinik und Poliklinik V, Mitglied des Deutschen Zentrums für Lungenforschung (Dzl), Klinikum der Universität München
,
D Munker
1   Medizinische Klinik und Poliklinik V, Mitglied des Deutschen Zentrums für Lungenforschung (Dzl), Klinikum der Universität München
,
T Kauke
2   Department of Thoracic Surgery, University of Munich
,
M Zoller
3   Department of Anaesthesiology, University of Munich
,
S Michel
4   Clinic of Cardiac Surgery, University of Munich
,
F Ceelen
5   Department of Internal Medicine V, Comprehensive Pneumology Center (Cpc-M), Member of the German Center for Lung Research (Dzl), University of Munich
,
J Barton
5   Department of Internal Medicine V, Comprehensive Pneumology Center (Cpc-M), Member of the German Center for Lung Research (Dzl), University of Munich
,
P Arnold
5   Department of Internal Medicine V, Comprehensive Pneumology Center (Cpc-M), Member of the German Center for Lung Research (Dzl), University of Munich
,
K Milger
5   Department of Internal Medicine V, Comprehensive Pneumology Center (Cpc-M), Member of the German Center for Lung Research (Dzl), University of Munich
,
J Behr
5   Department of Internal Medicine V, Comprehensive Pneumology Center (Cpc-M), Member of the German Center for Lung Research (Dzl), University of Munich
,
N Kneidinger
5   Department of Internal Medicine V, Comprehensive Pneumology Center (Cpc-M), Member of the German Center for Lung Research (Dzl), University of Munich
› Author Affiliations
Further Information

Publication History

Publication Date:
28 February 2020 (online)

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Background: Cytomegalovirus (CMV)-infection remains a major cause of morbidity and mortality after lung transplantation. Treatment with currently available drugs poses treatment difficulties in some patients due to drug resistance or intolerability.

Methods: We report a series of eight lung transplant recipients with high or intermediate risk for CMV-infection and treatment failure upon standard care due to antiviral drug resistance and treatment limiting side effects. Genotypic testing for ganciclovir (GCV)- and foscarnet (FOS)-resistance using sequencing of sections of UL97-gene and UL54-gene revealed a GCV-associated resistance in 7 cases. One patient developed an allergic reaction after initiation of ganciclovir. As rescue therapy letermovir, recently approved for the prophylaxis of CMV-infection in patients after hematopoietic stem cell transplantation was initiated. Patients received 480 mg per day for a follow up of 35.1 ± 22.5 weeks. Efficacy and tolerability was assessed retrospectively. CMV-specific immunity was measured by use of T-Track® CMV (Lophius Biosciences GmbH, Regensburg, Germany). Immunity and resistance testing was performed on request of the treating physician.

Results: Mild nausea, vomiting and diarrhea were the only side effects of letermovir reported by a single patient. None of the patients developed atrial fibrillation or flutter. Myelotoxic and nephrotoxic events did not occur or were not aggravated, respectively. Organ biopsies revealed CMV gastritis in 2 cases, CMV gastritis/pneumonia in 1 case and CMV pneumonia/colitis in 1 case. A small adjustment of the tacrolimus dose was mandatory upon treatment initiation with letermovir. In four cases immunosuppression was switched to quadruple immunosuppression regimen. CMV-viral load could be decreased and cleared subsequently in all patients. CMV clearance was observed after 12.9 ± 12.8 weeks despite lack of CMV-immunity.

Conclusion: CMV-infection and -disease were successfully managed with letermovir. Letermovir was well tolerated and effective in treating CMV-infections in lung transplant recipients failing on currently available antiviral agents.