Maribavir in lung transplant recipients with cytomegalovirus infection: real-life experience.

IF 3.9 2区医学 Q1 INFECTIOUS DISEASES

Infection Pub Date : 2026-08-18 DOI:10.1007/s15010-026-02927-3

Tobias Veit, Stefan Trost, Teresa Kauke, Nina Engels, Gabriela Leuschner, Michael Gerckens, Carlo Mümmler, Sebastian Michel, Michael Zoller, Valeria Hackemann, Jürgen Behr, Nikolaus Kneidinger

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引用次数: 0

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.

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马里巴韦在巨细胞病毒感染肺移植受者中的应用：现实经验。

巨细胞病毒仍然是LTx受体的主要挑战。尽管抗病毒治疗取得了进展，但难治和耐药的巨细胞病毒感染仍然存在，而且最近批准的UL97激酶抑制剂maribavir的实际数据有限。方法：我们回顾性分析了2022年8月至2024年12月期间接受马里巴韦治疗的49例难治和耐药（R/R） CMV的LTx受体。结果：总体而言，34名患者（69.4%）实现了持续的病毒学应答，定义为完全的CMV DNA清除，中位数为11.5天后病毒载量下降> 1 log₁₀，中位数为24.8[7-54]天后病毒完全清除。治疗失败16例（32.7%）；14例（28.6%）患者在接受马里巴韦治疗期间检测到UL97耐药突变。无应答者的基线病毒载量较高（1万IU/ml: 53.3% vs. 20.6%; p = 0.047），病毒下降较慢(14 (6-85)vs. 10.5（2-27）天；p = 0.033)。在多变量分析中，较高的基线CMV病毒载量与马里巴韦耐药性独立相关（OR 3.729 / log₁₀增加，95% CI 1.360-10.226; p = 0.011）。结论：总之，马里巴韦是肺移植术后R/R CMV的重要治疗选择。然而，治疗失败，复发和耐药仍然很常见，强调需要仔细监测和进一步优化治疗策略。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Infection 医学-传染病学

CiteScore

12.50

自引率

1.30%

发文量

224

审稿时长

6-12 weeks

期刊介绍： Infection is a journal dedicated to serving as a global forum for the presentation and discussion of clinically relevant information on infectious diseases. Its primary goal is to engage readers and contributors from various regions around the world in the exchange of knowledge about the etiology, pathogenesis, diagnosis, and treatment of infectious diseases, both in outpatient and inpatient settings. The journal covers a wide range of topics, including: Etiology: The study of the causes of infectious diseases. Pathogenesis: The process by which an infectious agent causes disease. Diagnosis: The methods and techniques used to identify infectious diseases. Treatment: The medical interventions and strategies employed to treat infectious diseases. Public Health: Issues of local, regional, or international significance related to infectious diseases, including prevention, control, and management strategies. Hospital Epidemiology: The study of the spread of infectious diseases within healthcare settings and the measures to prevent nosocomial infections. In addition to these, Infection also includes a specialized "Images" section, which focuses on high-quality visual content, such as images, photographs, and microscopic slides, accompanied by brief abstracts. This section is designed to highlight the clinical and diagnostic value of visual aids in the field of infectious diseases, as many conditions present with characteristic clinical signs that can be diagnosed through inspection, and imaging and microscopy are crucial for accurate diagnosis. The journal's comprehensive approach ensures that it remains a valuable resource for healthcare professionals and researchers in the field of infectious diseases.