{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,19]],"date-time":"2026-03-19T05:17:44Z","timestamp":1773897464899,"version":"3.50.1"},"reference-count":26,"publisher":"Wiley","issue":"11","license":[{"start":{"date-parts":[[2021,10,28]],"date-time":"2021-10-28T00:00:00Z","timestamp":1635379200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Clinical Transplantation"],"published-print":{"date-parts":[[2021,11]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Letermovir (LTV) might be an alternative treatment to nephrotoxic foscarnet (FOS) in Ganciclovir (GCV) resistant cytomegalovirus (CMV) infection. However, its efficacy in controlling active CMV viremia is unclear, as it is only approved for CMV prophylaxis in hematopoietic stem\u2010cell transplantation.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This case series describes 14 kidney transplant recipients (KTR) with moderate\u2010level GCV resistant CMV infection, treated by different step\u2010down strategies after initial FOS therapy: (1) Observation without antiviral follow\u2010up or switch to valganciclovir (VGCV) (pre\u2010LTV era), and (2) Switch to LTV\u00b1VGCV (LTV era).<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>One patient died under FOS. Thirteen patients were followed under step\u2010down regimens. All but two patients had ongoing CMV viremia when stopping FOS. In pre\u2010LTV era, 5\/9 (56%) experienced a CMV breakthrough\u00a0&gt;\u00a010\u00a0000 IU\/ml calling for another course of FOS, as compared to 1\/4 (25%) in the LTV era. Addition of VGCV to LTV at low\u2010level viral breakthrough, addressing a possible developing resistance against LTV, prevented viral surge in two patients. In the pre\u2010LTV era, CMV\u2010related death or graft loss occurred in three of nine (33%), compared to no death or graft loss in the LTV era.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>A step\u2010down strategy combining LTV+VGCV, might allow to safely stop FOS at ongoing low\u2010level viremia.<\/jats:p><\/jats:sec>","DOI":"10.1111\/ctr.14401","type":"journal-article","created":{"date-parts":[[2021,6,28]],"date-time":"2021-06-28T18:21:31Z","timestamp":1624904491000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":14,"title":["Use of letermovir\u2010valganciclovir combination as a step\u2010down treatment after foscarnet for ganciclovir\u2010resistant CMV infection in kidney transplant recipients"],"prefix":"10.1111","volume":"35","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0687-3753","authenticated-orcid":false,"given":"Elena","family":"Rho","sequence":"first","affiliation":[{"name":"Division of Internal Medicine Cantonal Hospital of Winterthur  Winterthur Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bettina","family":"N\u00e4f","sequence":"additional","affiliation":[{"name":"Division of Nephrology University Hospital Zurich  Zurich Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Thomas F","family":"M\u00fcller","sequence":"additional","affiliation":[{"name":"Division of Nephrology University Hospital Zurich  Zurich Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5425-6453","authenticated-orcid":false,"given":"Rudolf P","family":"W\u00fcthrich","sequence":"additional","affiliation":[{"name":"Division of Nephrology University Hospital Zurich  Zurich Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5549-4798","authenticated-orcid":false,"given":"Thomas","family":"Schachter","sequence":"additional","affiliation":[{"name":"Division of Nephrology University Hospital Zurich  Zurich Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1050-2800","authenticated-orcid":false,"given":"Seraina","family":"von Moos","sequence":"additional","affiliation":[{"name":"Division of Nephrology University Hospital Zurich  Zurich Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2021,10,28]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1086\/528718"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1600-6143.2009.02617.x"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcv.2012.03.001"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1097\/TP.0000000000001825"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11908-019-0699-0"},{"key":"e_1_2_9_7_1","doi-asserted-by":"publisher","DOI":"10.3851\/IMP3129"},{"key":"e_1_2_9_8_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1399-0012.2007.00761.x"},{"key":"e_1_2_9_9_1","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/cix259"},{"key":"e_1_2_9_10_1","doi-asserted-by":"publisher","DOI":"10.1093\/jac\/dkq368"},{"key":"e_1_2_9_11_1","doi-asserted-by":"publisher","DOI":"10.1097\/TP.0b013e31821fad25"},{"key":"e_1_2_9_12_1","doi-asserted-by":"publisher","DOI":"10.1128\/AAC.00561-13"},{"key":"e_1_2_9_13_1","doi-asserted-by":"publisher","DOI":"10.1586\/eri.12.115"},{"key":"e_1_2_9_14_1","doi-asserted-by":"publisher","DOI":"10.1097\/TP.0000000000001418"},{"key":"e_1_2_9_15_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1706640"},{"key":"e_1_2_9_16_1","doi-asserted-by":"publisher","DOI":"10.1111\/ajt.15135"},{"key":"e_1_2_9_17_1","doi-asserted-by":"publisher","DOI":"10.1128\/AAC.01623-15"},{"key":"e_1_2_9_18_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1600-6143.2011.03530.x"},{"key":"e_1_2_9_19_1","doi-asserted-by":"publisher","DOI":"10.1128\/AAC.02337-18"},{"key":"e_1_2_9_20_1","doi-asserted-by":"publisher","DOI":"10.1097\/TP.0000000000002785"},{"key":"e_1_2_9_21_1","doi-asserted-by":"publisher","DOI":"10.1097\/TP.0000000000002886"},{"key":"e_1_2_9_22_1","doi-asserted-by":"publisher","DOI":"10.1097\/00007890-200004270-00037"},{"key":"e_1_2_9_23_1","doi-asserted-by":"publisher","DOI":"10.1097\/TP.0000000000002191"},{"key":"e_1_2_9_24_1","doi-asserted-by":"publisher","DOI":"10.1159\/000339789"},{"issue":"7","key":"e_1_2_9_25_1","article-title":"Suppression of CMV infection with letermovir in a kidney transplant patient","volume":"7","author":"Koepf US","year":"2020","journal-title":"Eur J Case Rep Intern Med"},{"key":"e_1_2_9_26_1","article-title":"Letermovir treatment for established cytomegalovirus infection in transplant recipients [abstract]","author":"Linder KKC","year":"2020","journal-title":"Am J Transplant"},{"key":"e_1_2_9_27_1","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/ciaa1713"}],"container-title":["Clinical Transplantation"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/ctr.14401","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/ctr.14401","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/ctr.14401","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,8,25]],"date-time":"2023-08-25T10:16:00Z","timestamp":1692958560000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/ctr.14401"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,10,28]]},"references-count":26,"journal-issue":{"issue":"11","published-print":{"date-parts":[[2021,11]]}},"alternative-id":["10.1111\/ctr.14401"],"URL":"https:\/\/doi.org\/10.1111\/ctr.14401","archive":["Portico"],"relation":{},"ISSN":["0902-0063","1399-0012"],"issn-type":[{"value":"0902-0063","type":"print"},{"value":"1399-0012","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,10,28]]},"assertion":[{"value":"2021-02-26","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2021-06-17","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2021-10-28","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e14401"}}