Successful Treatment with Letermovir in a Heart Transplant Recipient with UL97 Mutation Ganciclovir-Resistant Cytomegalovirus Colitis and Viremia A Case Report and Review of Literature

Tomonobu Yanase; Masaru Hatano; Chie Bujo; Masaki Tsuji; Junichi Ishida; Eisuke Amiya; Koh Okamoto; Masahiko Ando; Shogo Shimada; Osamu Kinoshita; Shuetsu Fukushi; Souichi Yamada; Minoru Ono; Issei Komuro

doi:10.1536/ihj.22-496

Case Reports

Successful Treatment with Letermovir in a Heart Transplant Recipient with UL97 Mutation Ganciclovir-Resistant Cytomegalovirus Colitis and Viremia

A Case Report and Review of Literature

Tomonobu Yanase, Masaru Hatano, Chie Bujo, Masaki Tsuji, Junichi Ishida, Eisuke Amiya, Koh Okamoto, Masahiko Ando, Shogo Shimada, Osamu Kinoshita, Shuetsu Fukushi, Souichi Yamada, Minoru Ono, Issei Komuro

Author information

Tomonobu Yanase
Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo
Masaru Hatano
Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo
Advanced Medical Center for Heart Failure, The University of Tokyo Hospital
Chie Bujo
Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo
Masaki Tsuji
Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo
Junichi Ishida
Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo
Eisuke Amiya
Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo
Department of Therapeutic Strategy for Heart Failure, The University of Tokyo
Koh Okamoto
Department of Infectious Diseases, Graduate School of Medicine, The University of Tokyo
Masahiko Ando
Department of Cardiac Surgery, Graduate School of Medicine, The University of Tokyo
Shogo Shimada
Department of Cardiac Surgery, Graduate School of Medicine, The University of Tokyo
Osamu Kinoshita
Department of Cardiac Surgery, Graduate School of Medicine, The University of Tokyo
Shuetsu Fukushi
Department of Virology 1, National Institute of Infectious Diseases
Souichi Yamada
Department of Virology 1, National Institute of Infectious Diseases
Minoru Ono
Department of Cardiac Surgery, Graduate School of Medicine, The University of Tokyo
Issei Komuro
Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo

Keywords: Heart transplantation, Acute cellular rejection, Chronic kidney disease, Cytomegalovirus-pp65 antigenemia

JOURNAL FREE ACCESS

2023 Volume 64 Issue 1 Pages 95-99

DOI https://doi.org/10.1536/ihj.22-496

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Abstract

Currently available anti-cytomegalovirus (CMV) agents are sometimes poorly tolerated, owing to their side effects. Letermovir is a novel anti-CMV drug that is only approved for CMV prophylaxis in hematopoietic stem cell transplant recipients, with fewer side effects. We report the case of a heart transplant recipient with UL97 mutation (L595F) ganciclovir-resistant cytomegalovirus colitis who was successfully treated with off-label use of letermovir. In treating CMV infection or disease with letermovir, a transient rise or lag in the clearance of CMV-DNA polymerase chain reaction levels has been observed. Our case suggests that CMV-pp65 antigenemia can be an additional marker of treatment efficacy.

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