Case Report: Management of a Multidrug-Resistant CMV-Strain in a Renal Transplant Recipient by High-Dose CMV-Specific Immunoglobulins, Modulation in Immunosuppression, and Induction of CMV-Specific Cellular Immunity

Wiening, Vanessa; Schmidt, Tina; Dahmen, Maximilian; Siam, Sami; Reuter, Stefan; Pavenstädt, Hermann-Joseph; Sester, Martina; Suwelack, Barbara

doi:10.3389/fimmu.2020.623178

Cited by 1 publication

(1 citation statement)

References 25 publications

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“…101 It is often used as a multipronged strategy in the treatment of refractory or resistance, or when other therapies are not tolerated, with varying success documented. 3,[102][103][104] Neutralizing monoclonal antibodies derived from CMVseropositive patients have been isolated and are attractive future treatment candidates for CMV prevention and treatment. 105 Administration of a combination of 2 neutralizing antibodies to CMV (RG7667) was evaluated in kidney CMV-seronegative kidney transplant recipients in a phase 2A clinical trial (n = 120).…”

Section: Immunoglobulinsmentioning

confidence: 99%

What’s New: Updates on Cytomegalovirus in Solid Organ Transplantation

Stewart,

Kotton

2023

Transplantation

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Cytomegalovirus (CMV) is one of the most common infections occurring after solid organ transplantation. This high burden of disease, which incurs sizeable morbidity, may be worsening with the proportion of high-risk D+/R− solid organ transplantation recipients increasing in some regions globally. Cohort studies continue to support either universal prophylaxis or preemptive therapy as effective prevention strategies. Letermovir prophylaxis was noninferior to valganciclovir in adult high-risk D+/R− kidney transplant recipients with fewer drug-related adverse events in a recent clinical trial and has now been approved for such use in some regions. Maribavir preemptive therapy failed to demonstrate noninferiority when compared with valganciclovir in hematopoietic stem cell transplant recipients but looked promising for safety. Donor matching could be useful in prevention CMV disease with a survival advantage demonstrated in seronegative recipients waiting up to 30 mo for a seronegative kidney. Immune-guided prophylaxis resulted in fewer CMV infection episodes in lung transplant recipients when compared with fixed-duration prophylaxis in a recent clinical trial. For treatment of refractory or resistant CMV infection, maribavir was more efficacious and better tolerated when compared with investigator-initiated therapy in its registration trial for this condition. Further research regarding best treatment and prophylaxis of resistant or refractory CMV infection is needed to reflect best clinical practice choices. Optimal use of immune globulin or CMV-specific T cells for prevention or treatment of CMV disease remains undefined. Standardized definitions for the design of CMV clinical trials have been developed. In this review, we highlight recent updates in the field from data published since 2018.

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