Abstract: SA-PO0687
Letermovir for Cytomegalovirus Prophylaxis in Pediatric Kidney Transplant Recipients with Valganciclovir-Associated Leukopenia
Session Information
- Pediatric Nephrology: Transplantation, Hypertension, AKI, Genetics, and Developmental Diseases
November 08, 2025 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Pediatric Nephrology
- 1900 Pediatric Nephrology
Authors
- Ranabothu, Saritha, University of Arkansas System, Little Rock, Arkansas, United States
- Blake, Laura, Arkansas Children's Hospital, Little Rock, Arkansas, United States
Background
Cytomegalovirus (CMV) remains a leading infectious complication in pediatric kidney transplant recipients, especially in high-risk (D+/R-) patients. Valganciclovir, commonly used for CMV prophylaxis for up to 6 months post-transplant, can be associated with leukopenia, which may necessitate alternative therapies. Letermovir, recently approved for CMV prophylaxis in high-risk kidney transplant recipients 12 years and older, may offer a safer alternative in select pediatric patients. There is not much data available on the safety and efficacy of letermovir use in pediatric kidney transplants when switched from valganciclovir due to adverse effects.
Methods
This is a retrospective chart review on outcomes in high- to moderate-risk pediatric kidney transplant recipients switched from valganciclovir to letermovir for CMV prophylaxis due to leukopenia. Data collected included patient demographics (Table 1), transplant characteristics, white blood cell (WBC) count, incidence of CMV viremia, and adverse events
Results
Four high- to moderate-risk pediatric kidney transplant recipients (median age 17 years) were included. The switch to letermovir occurred at a median of 13 weeks post-transplant due to valganciclovir-induced leukopenia. Following the switch, WBC count improved significantly in all patients, with a mean increase of 4.75 K/µL at 1-2 weeks. Filgrastim was administered to all patients, potentially influencing WBC count. Following the switch to letermovir, 2 patients no longer required filgrastim use. Three patients did not develop CMV viremia during letermovir use (median duration 10 weeks). One patient remains on letermovir, and their response is not yet accurately assessable. Letermovir was well-tolerated with no adverse events.
Conclusion
Letermovir is a promising alternative for CMV prophylaxis in high- to moderate-risk pediatric kidney transplants experiencing valganciclovir-induced leukopenia. Its use resulted in hematologic recovery without compromising CMV prevention. Prospective studies are needed to confirm these findings.
| Study ID | Age | Gender | Type of kidney transplant | CMV status | Induction immunosuppression | Weeks on valganciclovir post-transplant | Pre-switch WBC | Post switch WBC at 1-2 weeks | Weeks on letermovir post switch |
| 1 | 12 | F | DDKT | D-/R+ | ATG | 3 | 1.95 K/µL | 8.77 K/µL | ongoing |
| 2 | 17 | M | DDKT | D+/R- | ATG | 13 | 1.55 K/µL | 5.44 K/µL | 10 |
| 3 | 17 | M | DDKT | D+/R- | ATG | 12 | 0.90 K/µL | 5.41 K/µL | 13 |
| 4 | 18 | F | DDKT | D+/R+ | ATG | 13 | 2.39 K/µL | 6.20 K/µL | 10 |
DDKT: deceased donor kidney transplant ATG: antithymocyte globulin