De Novo Letermovir for Cytomegalovirus Primary Prophylaxis in Heart Transplant Recipients: A Case Series

ABSTRACT Background Cytomegalovirus (CMV) is a significant infection affecting solid organ transplant recipients (SOTr). Valganciclovir is the drug of choice for CMV prophylaxis but is associated with an undesirable side effect profile. Letermovir, a CMV DNA terminase complex inhibitor, is not associated with the myelotoxicity seen with valganciclovir. Currently, letermovir is approved for CMV prophylaxis in hematopoietic cell and kidney transplant recipients, but not for heart transplant recipients (HTR), where data are very minimal. Methods A chart review was conducted on 22 patients who received letermovir post‐heart transplantation for CMV prophylaxis at an academic medical center. Patients were monitored for CMV disease, CMV DNAemia, CMV blip, and myelotoxicity. Results Most patients (81.8%) were at moderate risk for CMV disease (CMV seropositive/negative donor and CMV‐seropositive recipient). Of the 22 patients, 12 completed CMV prophylaxis with letermovir, while 10 were switched to valganciclovir, primarily due to insurance non‐coverage (9 out of 10 patients). One patient developed a CMV blip to 297 IU/mL and was switched to valganciclovir. No patients developed CMV infection or disease while on letermovir, and no myelotoxicity was observed. Conclusions Letermovir may be a potential option for primary prevention of CMV prophylaxis in HTR.