{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,13]],"date-time":"2026-03-13T07:37:49Z","timestamp":1773387469006,"version":"3.50.1"},"reference-count":25,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2021,12,7]],"date-time":"2021-12-07T00:00:00Z","timestamp":1638835200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Clinical Transplantation"],"published-print":{"date-parts":[[2022,2]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>Cytomegalovirus (CMV) infection remains a major challenge in solid organ transplantation. Ganciclovir has changed the prognosis, but with the expense of possible viral resistance. New antiviral drugs, such as letermovir, have not been studied sufficiently in kidney and pancreas transplant recipients. We reviewed abdominal organ transplants recipients with CMV infection from the national transplant registry and identified patients treated with letermovir from electronic medical records. We report on letermovir treatment in one kidney and three simultaneous pancreas and kidney (SPK) transplant patients with refractory or ganciclovir\u2010resistant CMV infection (UL54\/ UL97 mutation). In SPK patients, persistent leukopenia undermined immunosuppressive and antiviral treatment, favoring life\u2010threatening bacterial infections or ganciclovir resistance. All patients achieved viral clearance after letermovir monotherapy of 1.5\u20136 months. Letermovir was well tolerated and leukopenia resolved. Adjustments of calcineurin inhibitor doses were challenging. One acute rejection occurred because of under immunosuppression. After the end of treatment, recurrent low\u2010grade CMV\u2010DNAemia was common requiring reinitiating antiviral therapy to achieve viral clearance. To conclude, letermovir was a well\u2010tolerated valuable option for the treatment of refractory or resistant CMV infection in kidney and pancreas transplantation.<\/jats:p>","DOI":"10.1111\/ctr.14537","type":"journal-article","created":{"date-parts":[[2021,11,19]],"date-time":"2021-11-19T15:30:07Z","timestamp":1637335807000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":15,"title":["Letermovir treatment for CMV infection in kidney and pancreas transplantation: A valuable option for complicated cases"],"prefix":"10.1111","volume":"36","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0462-4833","authenticated-orcid":false,"given":"Fernanda","family":"Ortiz","sequence":"first","affiliation":[{"name":"Department of Nephrology Abdominal Center Unit Helsinki University Hospital and University of Helsinki Helsinki Finland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marko","family":"Lempinen","sequence":"additional","affiliation":[{"name":"Department of Transplantation and Liver Surgery Helsinki University Hospital and University of Helsinki Helsinki Finland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sari","family":"Aaltonen","sequence":"additional","affiliation":[{"name":"Department of Nephrology Abdominal Center Unit Helsinki University Hospital and University of Helsinki Helsinki Finland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Niina","family":"Koivuviita","sequence":"additional","affiliation":[{"name":"Department of Medicine Division of Nephrology Turku University Hospital Turku Finland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ilkka","family":"Helanter\u00e4","sequence":"additional","affiliation":[{"name":"Department of Transplantation and Liver Surgery Helsinki University Hospital and University of Helsinki Helsinki Finland"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2021,12,7]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1002\/rmv.2034"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.2217\/14750708.2.3.333"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.1097\/TP.0000000000002191"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.1111\/tid.12247"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.1021\/acs.jmedchem.9b01501"},{"key":"e_1_2_8_7_1","doi-asserted-by":"publisher","DOI":"10.1128\/AAC.01596-09"},{"key":"e_1_2_8_8_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1706640"},{"key":"e_1_2_8_9_1","article-title":"Letermovir and maribavir for the treatment and prevention of cytomegalovirus infection in solid organ and stem cell transplant recipients","author":"Imlay HN","year":"2020","journal-title":"Clin Infect 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cytomegalovirus infection: a case series and review of the literature","author":"Hofmann E","year":"2020","journal-title":"Transpl Infect Dis"},{"key":"e_1_2_8_20_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10096-020-03990-w"},{"key":"e_1_2_8_21_1","doi-asserted-by":"crossref","first-page":"e13570","DOI":"10.1111\/tid.13570","article-title":"Letermovir prophylaxis in solid organ transplant\u2010Assessing CMV breakthrough and tacrolimus drug interaction","author":"Winstead R","year":"2021","journal-title":"Transpl Infect Dis"},{"key":"e_1_2_8_22_1","doi-asserted-by":"publisher","DOI":"10.1111\/tid.13693"},{"key":"e_1_2_8_23_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1600-6143.2009.02699.x"},{"key":"e_1_2_8_24_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1399-0012.2009.01127.x"},{"key":"e_1_2_8_25_1","first-page":"9429265","article-title":"Drug\u2010induced hematological cytopenia in kidney transplantation and the challenges it poses for kidney transplant 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