Cytomegalovirus prevention in thoracic organ transplantation: A single-center evaluation of letermovir prophylaxis.
Cytomegalovirus prevention in thoracic organ transplantation: A single-center evaluation of letermovir prophylaxis.
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DOI：
10.1016/j.healun.2021.12.005
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发表时间：
2022-04
影响因子：
8.9
通讯作者：
Wolfe, Cameron R.
中科院分区：
文献类型：
--
作者：
Saullo, Jennifer L.;Baker, Arthur W.;Snyder, Laurie D.;Reynolds, John M.;Zaffiri, Lorenzo;Eichenberger, Emily M.;Ferrari, Alana;Steinbrink, Julie M.;Maziarz, Eileen K.;Bacchus, Melissa;Berry, Holly;Kakoullis, Stylianos A.;Wolfe, Cameron R.
巨细胞病毒（CMV）感染是常见的胸部器官移植后，并导致大量的发病率和死亡率。莱特莫韦是一种新型抗病毒药物，用于该人群的CMV预防。我们的目标是了解莱特莫韦的使用模式和有效性时，应用于胸部移植后的CMV预防。我们回顾性评估了在一家学术移植中心的胸移植受者中使用莱特莫韦的情况，这些受者从2018年1月至2019年10月开始使用莱特莫韦进行CMV预防。我们分析了预防的适应症、时间和持续时间;耐受性;以及突破性CMV DNA血症和疾病的发生。在41名患者中发生了42次莱特莫韦预防性发作，其中包括37名肺移植受者和4名心脏移植受者。主要由于骨髓抑制（25/26，96.2%）而使用一级预防（26/42，61.9%），并在移植后中位315天（四分位距[IQR] 125-1139天）开始。由于骨髓抑制（10/16，62.5%）或既往CMV耐药（6/16，37.5%），在移植后中位数695天（IQR 537-1156天）开始了16次二级预防（16/42，38.1%）。莱特莫韦预防治疗的中位持续时间为282天（IQR 131-433天）。在5/42（11.9%）次发作中，不良反应需要停用莱特莫韦。只有1例（2.4%）并发有临床意义的突破性CMV感染。15例（35.7%）发生一过性低水平CMV DNA血症（< 450 IU/mL），但不需要停用莱特莫韦。莱特莫韦在延长的预防疗程中耐受性良好且有效，该胸部移植受者队列中只有一例突破性CMV感染。在这一人群中进行莱特莫韦预防的进一步前瞻性试验是必要的。
Cytomegalovirus (CMV) infection is common following thoracic organ transplantation and causes substantial morbidity and mortality. Letermovir is a novel antiviral agent used off-label in this population for CMV prevention. Our goal was to understand patterns of letermovir use and effectiveness when applied for CMV prophylaxis after thoracic transplantation. We retrospectively evaluated letermovir use among thoracic transplant recipients at an academic transplant center who initiated letermovir from 1/2018 – 10/2019 for CMV prophylaxis. We analyzed indication, timing, and duration of prophylaxis; tolerability; and occurrence of breakthrough CMV DNAemia and disease. Forty-two episodes of letermovir prophylaxis occurred in 41 patients, including 37 lung and 4 heart transplant recipients. Primary prophylaxis (26/42, 61.9%) was utilized mainly due to myelosuppression (25/26, 96.2%) and was initiated a median of 315 days post-transplant (interquartile range [IQR] 125–1139 days). Sixteen episodes of secondary prophylaxis (16/42, 38.1%) were initiated a median of 695 days post-transplant (IQR 537–1156 days) due to myelosuppression (10/16, 62.5%) or prior CMV resistance (6/16, 37.5%). Median duration of letermovir prophylaxis was 282 days (IQR 131–433 days). Adverse effects required letermovir cessation in 5/42 (11.9%) episodes. Only one episode (2.4%) was complicated by clinically significant breakthrough CMV infection. Transient low-level CMV DNAemia (< 450 IU/mL) occurred in 15 episodes (35.7%) but did not require letermovir cessation. Letermovir was well tolerated and effective during extended prophylactic courses with only one case of breakthrough CMV infection in this cohort of thoracic transplant recipients. Further prospective trials of letermovir prophylaxis in this population are warranted.
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DOI：
10.12890/2020_001622
发表时间：
2020-01-01
影响因子：
--
作者：
Koepf, Uta S;Klehr, Hans U;Lutz, Philipp
通讯作者：
Lutz, Philipp
影响因子：
2.1
作者：
Razonable, Raymund R.;Humar, Atul
通讯作者：
Humar, Atul
影响因子：
4.9
作者：
Chou, Sunwen
通讯作者：
Chou, Sunwen
影响因子：
5.2
作者：
Alain, S.;Feghoul, L.;Hantz, S.
通讯作者：
Hantz, S.
影响因子：
11.8
作者：
Ljungman, Per;Boeckh, Michael;Griffiths, Paul D.
通讯作者：
Griffiths, Paul D.