Cytomegalovirus (CMV) is a common viral pathogen in the transplant population and is associated with significant morbidity and mortality. CMV prevention is paramount; however, selecting the best preventive strategy depends on many factors including donor–recipient CMV serostatus, transplant-specific risks, antiviral toxicities and cost. Novel CMV therapeutics such as letermovir (LTV) are desperately needed to optimize CMV management. Uniquely among CMV antiviral therapies, LTV inhibits the viral terminase complex in the CMV DNA synthesis pathway and disrupts viral genome packaging. Further, it lacks side effects frequently associated with other CMV antiviral therapies and evades common mechanisms of resistance. LTV is approved by the US Food and Drug Administration for CMV prevention in adult CMV-seropositive hematopoietic cell transplant recipients but is increasingly applied off-label for prophylaxis and treatment. This review summarizes important concepts of CMV management in transplantation, with a specific focus on LTV pharmacology and clinical experience to date alongside future prospects for its application.

中文翻译：

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巨细胞病毒治疗：莱特莫韦在移植受者预防和治疗中的作用

巨细胞病毒（CMV）是移植群体中常见的病毒病原体，与显着的发病率和死亡率相关。 CMV 预防至关重要；然而，选择最佳预防策略取决于许多因素，包括供体-受体 CMV 血清状态、移植特异性风险、抗病毒毒性和成本。迫切需要诸如莱特莫韦 (LTV) 等新型 CMV 疗法来优化 CMV 管理。在 CMV 抗病毒疗法中，LTV 是独一无二的，它抑制 CMV DNA 合成途径中的病毒终止酶复合物，并破坏病毒基因组包装。此外，它没有其他 CMV 抗病毒疗法常见的副作用，并且规避了常见的耐药机制。 LTV 经美国食品和药物管理局批准用于成人 CMV 血清阳性造血细胞移植受者的 CMV 预防，但越来越多地在标签外用于预防和治疗。这篇综述总结了移植中 CMV 管理的重要概念，特别关注 LTV 药理学和迄今为止的临床经验以及其应用的未来前景。