B223 - Maribavir Treatment for Resistant Cytomegalovirus Infection in Pediatric Kidney Recipients: Two Case Reports

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Author Block: E. Cheyssac¹, A. Sellier-Leclerc², F. Louillet³, J. Hogan⁴, ¹Pediatric Nephrology, Robert Debré Hospital, Paris, France, ²Pediatric Nephrology, Hôpital Femme Mère Enfant, Lyon, France, ³Pediatric Nephrology, Rouen University Hospital, Rouen, France, ⁴Pediatric Nephrology, Paris Institute for Transplantation and Organ Regeneration, Paris Cité University, Robert Debré Hospital, Paris, France
*Purpose: Cytomegalovirus (CMV) is a frequent and serious complication in kidney transplant recipients. Refractory or resistant CMV infections are particularly challenging to treat. Maribavir, a UL97 kinase inhibitor, has shown superior efficacy and better tolerability compared to standard therapies in adult patients in previous trials. However, there is a lack of knowledge regarding its use in pediatric kidney transplant recipients. We report two pediatric cases illustrating the use of innovative antiviral therapies (maribavir and letermovir) in this setting.
*Methods: We report two pediatric cases illustrating the off-label use of innovative antiviral therapies (maribavir and letermovir) in this setting.
*Results: Two pediatric kidney recipients with a CMV D+/R− status, developed a primary CMV infection. Classical treatment with ganciclovir failed to obtain complete viral suppression. After confirmed resistances to ganciclovir with a UL97 mutation, both received maribavir (400 mg twice a day) during 8weeks. In both cases, treatment with maribavir led to complete viral clearance with nosignificant cytopenias and preserved graft function. Maribavir was switched for letermovir with no recurrence of viremia.
*Conclusions: These cases support the efficacy and good tolerance of using maribavir for the treatment of resistant CMV infections in pediatric kidney transplant recipients. Nevertheless, larger pediatric studies are needed to confirm the safety, and optimal management of these therapies in this specific population.