Maribavir in lung transplant recipients with cytomegalovirus infection: real-life experience
8 affiliations
- 1Department of Medicine V, LMU University Hospital, Comprehensive Pneumology Center (CPC-M), LMU Munich, Member of the German Center for Lung Research (DZL), Marchioninistrasse 15, 81377 Munich, Germany
- 2Laboratory for Immunogenetics, University of Munich, LMU, Munich, Germany
- 3Division of Thoracic Surgery, LMU University Hospital, LMU Munich, Member of the German Center for Lung Research (DZL), Munich, Germany
- 4Institute of Lung Health and Immunity (LHI), Comprehensive Pneumology Center (CPC), Helmholtz Munich, Member of the German Center of Lung Research (DZL), Munich, Germany
- 5Department of Cardiac Surgery, LMU University Hospital, LMU Munich, Member of the German Center for Lung Research (DZL), Munich, Germany
- 6Department of Anaesthesiology, University Hospital, LMU, Munich, Germany
- 7Max Von Pettenkofer Institute and Gene Center, Virology, National Reference Center for Retroviruses, LMU, Munich, Germany
- 8Department of Internal Medicine, Division of Respiratory Medicine, Lung Research Cluster, Medical University of Graz, Auenbruggerplatz 15, 8036 Graz, Austria
Abstract
Introduction: Cytomegalovirus remains a major challenge in LTx recipients. Despite advances in antiviral therapy, refractory and resistant CMV infections persist, and real-world data on maribavir, a recently approved UL97 kinase inhibitor, are limited.
Methods: We retrospectively analyzed 49 LTx recipients treated with maribavir for refractory and resistant (R/R) CMV between August 2022 and December 2024.
Results: Overall, 34 patients (69.4%) achieved a sustained virological response, defined as complete CMV DNA clearance, with a > 1 log₁₀ viral load decline after a median of 11.5 days and complete viral clearance after a median of 24.8 [7–54] days. Sixteen patients (32.7%) failed therapy; UL97 resistance mutations were detected during maribavir therapy in 14 patients (28.6%). Non-responders had higher baseline viral loads (> 10,000 IU/ml: 53.3% vs. 20.6%; p = 0.047) and slower viral decline (14 (6–85) vs. 10.5 (2–27) days; p = 0.033). In multivariable analysis, higher baseline CMV viral load was independently associated with maribavir resistance (OR 3.729 per log₁₀ increase, 95% CI 1.360–10.226; p = 0.011).
Conclusion: In conclusion, maribavir represents an important therapeutic option for R/R CMV after lung transplantation. However, treatment failure, relapse, and resistance remained common, highlighting the need for careful monitoring and further optimization of treatment strategies.
Supplementary Information: The online version contains supplementary material available at https://doi.org/10.1007/s15010-026-02927-3.
Related
- Virologic and Exploratory Immunologic Characterization of Relapsing Human Cytomegalovirus (HCMV) DNAemia in Solid Organ Transplant Recipients: A Prospective Observational Cohort Study
- Response to antiviral therapy in haematopoietic stem cell transplant recipients with cytomegalovirus (CMV) reactivation according to the donor CMV serological status
- Cytomegalovirus: Updated Approach to Management for Kidney Transplant Recipients
- Risk Factors and Outcomes of Vancomycin-Resistant Enterococcus faecium Bloodstream Infection in Hematologic Malignancies and Stem Cell Transplant Recipients: A Case-Control Study
- Surgical site infection in liver transplant recipients: risk factors and microbial agents from a high volume liver transplant center in Iran
BibTeX
@article{veit2026maribavir,
title = {{Maribavir in lung transplant recipients with cytomegalovirus infection: real-life experience}},
author = {Tobias Veit and Stefan Trost and Teresa Kauke and Nina Engels and Gabriela Leuschner and Michael Gerckens and Carlo Mümmler and Sebastian Michel and Michael Zoller and Valeria Hackemann and Jürgen Behr and Nikolaus Kneidinger},
journal = {Infection},
year = {2026},
month = aug,
doi = {10.1007/s15010-026-02927-3},
url = {https://doi.org/10.1007/s15010-026-02927-3},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Maribavir in lung transplant recipients with cytomegalovirus infection: real-life experience
AU - Tobias Veit
AU - Stefan Trost
AU - Teresa Kauke
AU - Nina Engels
AU - Gabriela Leuschner
AU - Michael Gerckens
AU - Carlo Mümmler
AU - Sebastian Michel
AU - Michael Zoller
AU - Valeria Hackemann
AU - Jürgen Behr
AU - Nikolaus Kneidinger
PY - 2026
DA - 2026/08/18
JO - Infection
DO - 10.1007/s15010-026-02927-3
UR - https://doi.org/10.1007/s15010-026-02927-3
AB - Introduction: Cytomegalovirus remains a major challenge in LTx recipients. Despite advances in antiviral therapy, refractory and resistant CMV infections persist, and real-world data on maribavir, a recently approved UL97 kinase inhibitor, are limited. Methods: We retrospectively analyzed 49 LTx recipients treated with maribavir for refractory and resistant (R/R) CMV between August 2022 and December 2024. Results: Overall, 34 patients (69.4%) achieved a sustained virological response, defined as complete CMV DNA clearance, with a > 1 log₁₀ viral load decline after a median of 11.5 days and complete viral clearance after a median of 24.8 [7–54] days. Sixteen patients (32.7%) failed therapy; UL97 resistance mutations were detected during maribavir therapy in 14 patients (28.6%). Non-responders had higher baseline viral loads (> 10,000 IU/ml: 53.3% vs. 20.6%; p = 0.047) and slower viral decline (14 (6–85) vs. 10.5 (2–27) days; p = 0.033). In multivariable analysis, higher baseline CMV viral load was independently associated with maribavir resistance (OR 3.729 per log₁₀ increase, 95% CI 1.360–10.226; p = 0.011). Conclusion: In conclusion, maribavir represents an important therapeutic option for R/R CMV after lung transplantation. However, treatment failure, relapse, and resistance remained common, highlighting the need for careful monitoring and further optimization of treatment strategies. Supplementary Information: The online version contains supplementary material available at https://doi.org/10.1007/s15010-026-02927-3.
SN - 0300-8126
SN - 1439-0973
ER -