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Letermovir was recently approved for prophylaxis in adult kidney-transplant recipients (KTRs) without prior cytomegalovirus (CMV) infection (R−) who received transplants from donors with CMV infection (D+). Letermovir's unique mechanism of action and the resistance-associated amino acid substitution (RAS) viral mutations have yet to be fully examined. Now, in a study supported by the letermovir manufacturer, plasma samples that had been collected during a prior trial of letermovir versus valganciclovir in D+/R− adult KTRs were tested with genotyping if CMV DNA was detected (see NEJM JW Infect Dis Jun 15 2023 and JAMA 2023; 330:33). Genomic regions associated with resistance to letermovir and to valganciclovir were amplified and sequenced; p…