Use of letermovir‐valganciclovir combination as a step‐down treatment after foscarnet for ganciclovir‐resistant CMV infection in kidney transplant recipients

• DOI: 10.1111/ctr.14401
• Publication Date: 2021-06-28T18:21:31Z
• Authors: Elena Rho; Bettina Näf; Thomas F Müller; Rudolf P Wüthrich; Thomas Schachter; Seraina von Moos
• Keywords: Valganciclovir; Foscarnet; Viremia; Cytomegalovirus

Letermovir (LTV) might be an alternative treatment to nephrotoxic foscarnet (FOS) in Ganciclovir (GCV) resistant cytomegalovirus (CMV) infection. However, its efficacy controlling active CMV viremia is unclear, as it only approved for prophylaxis hematopoietic stem-cell transplantation.This case series describes 14 kidney transplant recipients (KTR) with moderate-level GCV infection, treated by different step-down strategies after initial FOS therapy: (1) Observation without antiviral follow-up or switch valganciclovir (VGCV) (pre-LTV era), and (2) Switch LTV±VGCV (LTV era).One patient died under FOS. Thirteen patients were followed regimens. All but two had ongoing when stopping In pre-LTV era, 5/9 (56%) experienced a breakthrough > 10 000 IU/ml calling another course of FOS, compared 1/4 (25%) the LTV era. Addition VGCV at low-level viral breakthrough, addressing possible developing resistance against LTV, prevented surge patients. CMV-related death graft loss occurred three nine (33%), no era.A strategy combining LTV+VGCV, allow safely stop viremia.