De Novo Letermovir for Cytomegalovirus Prophylaxis in High‐Risk Liver Transplant Recipients

• DOI: 10.1111/ctr.70169
• Publication Date: 2025-04-28T17:37:05Z
• Authors: Hanna L. Kleiboeker; Jillian L. Descou...; Chris M. Saddler; David Al‐Adra; John P. Rice; Margaret R. Jorge...
• Keywords: Valganciclovir; Serostatus; Tolerability

ABSTRACT Background Cytomegalovirus (CMV) drives negative outcomes after liver transplant (LT), with patients having high‐risk serostatuses (D+/R−) being especially vulnerable. While valganciclovir (VGC) remains the standard‐of‐care, letermovir (LTV) represents a promising potential in LT, given reduced myelosuppression. Methods Adult receiving an LT CMV serostatus June 1, 2021–June 6, 2024 were evaluated. Patients included standard‐of‐care (SOC) or LTV cohort based on de novo antiviral prophylaxis regimen. The primary objective was safety and tolerability of VGC compared to LTV. Results Sixty‐one met inclusion criteria: 35 SOC 26 cohorts. A significantly higher proportion completed (28.6% vs. 80.8%, p < 0.001), most experiencing intolerance (71.4%). No terminated due breakthrough. had lower white blood cell (1.6 2.75 × 10 3 cells/mm3; 0.001) absolute neutrophil (850 2260 cells/µL = 0.003) nadir at 6 months. Significantly more required granulocyte‐colony stimulating factor (57.1% 15.4%, 0.001). tolerated doses mycophenolate through 12 months post‐transplant. Conclusion De for appears be safe effective. is likely successfully than current associated less myelosuppressive toxicity, which allows maintenance doses. Future studies are needed evaluate impact rejection rates outcomes.