Residents and Fellows Research in Progress
Monday, October 14, 2024
01:00 PM–02:30 PM
Abstract
Introduction: Cytomegalovirus (CMV), a common opportunistic pathogen associated with infection and tissue invasive disease post lung transplantation, accounts for substantial morbidity and mortality. Primary CMV prophylaxis in this population traditionally utilizes valganciclovir; however, this approach is commonly associated with treatment-limiting side effects (e.g., leukopenia). Letermovir, a novel antiviral agent, offers a promising alternative with improved tolerability and demonstrated efficacy in kidney transplant recipients supporting further study in other solid organ transplant types.
Research Question or Hypothesis: Letermovir is a safe and efficacious option for primary CMV prophylaxis in lung transplant recipients.
Study Design: Single-center, retrospective cohort study
Methods: This single-center, retrospective cohort study included adult lung transplant recipients from August 2011 to January 2023 switched from valganciclovir to letermovir. Patients who received letermovir for treatment or secondary prophylaxis were excluded. The primary outcome was cumulative incidence of the composite of CMV syndrome and CMV end-organ disease. Secondary outcomes included cumulative incidence of CMV syndrome, CMV disease, CMV DNAemia, and all-cause mortality, as well as time to occurrence of each outcome. Safety outcomes included cumulative incidence of leukopenia, neutropenia, and thrombocytopenia. All patients were adjudicated at the end of the study, defined as the last day of follow-up, death, or retransplant.
Results: 101 patients were screened, and 50 met the inclusion criteria. The most common reason for exclusion was secondary prophylaxis in 21(42%) patients. Fourteen (28%) patients were at high risk for CMV infection. The median age was 64 years (IQR 53-68), and the primary reason for transplant was pulmonary fibrosis (30 patients [60%]). The primary documented reason for switching to letermovir was leukopenia. No patients developed CMV syndrome or end-organ disease. A total of 3(6%) patients developed CMV DNAemia. Further data analysis pending.
Conclusion: Letermovir appears to be a safe and efficacious agent for primary CMV prophylaxis in lung transplant recipients.
Presenting Author
Mahbouba Ahmadi Pharm.D.University of Texas Southwestern Medical Center
Authors
Jessica Francois Whitt Pharm.D.
University of Texas Southwestern Medical Center
Ricardo La Hoz M.D.
University of Texas Southwestern Medical Center
Marguerite Monogue Pharm.D.
University of Texas Southwestern Medical Center
Van Ngo Pharm.D.
University of Texas Southwestern Medical Center
Mary Olumesi Pharm.D.
University of Texas Southwestern Medical Center
James Sanders Pharm.D., Ph.D.
University of Texas Southwestern Medical Center