Real‐World Use of Letermovir and Maribavir for <scp>CMV</scp> Prophylaxis and Treatment in Solid Organ Transplant Recipients: Clinical Outcomes and Resistance Patterns From a Dual‐Center Cohort
Bibliographic record
Abstract
BACKGROUND: Cytomegalovirus (CMV) is a major opportunistic infection in solid organ transplant (SOT) recipients. Although valganciclovir is first-line for CMV treatment, its use may be limited by resistance and myelotoxicity. Letermovir (LET) and maribavir (MBV) are increasingly used as alternative therapies, though real-world outcomes remain incompletely defined. This study evaluated real-world outcomes of LET and MBV in SOT recipients for whom standard CMV therapy was inadequate or not feasible. Viral clearance, breakthrough infection, refractory infection, and resistance emergence were assessed. METHODS: We conducted a retrospective cohort analysis of adult SOT patients receiving LET (2018-2025) and/or MBV (2019-2025) at two transplant centers. Primary outcomes included CMV breakthrough (≥ 500 IU/mL) during LET prophylaxis and CMV clearance (< 200 IU/mL) at the end of MBV treatment. Secondary outcomes included resistant, refractory, and recurrent CMV infection within 3 months post-therapy. RESULTS: Among 47 LET courses (41 patients), breakthrough CMV occurred in 14/32 (44%) secondary prophylaxis (SP) courses (median viral load [VL]: 1037 IU/mL, interquartile range [IQR] 673-3427) but in none of the 15 primary prophylaxis (PP) courses. No resistance to LET was detected during or after prophylaxis. MBV was administered in 21 courses (17 patients); MBV-refractory/resistant (R/R) infection occurred in 8 courses (38%), and 11 (52%) courses achieved CMV clearance. Within 3 months post-MBV, 14 (67%) courses had CMV VL ≥ 1000 IU/mL, and two (10%) courses experienced recurrence. MBV resistance emerged in 6/17 (35%) patients during or after treatment. CONCLUSIONS: LET was effective for PP but associated with frequent breakthroughs in SP patients. MBV was limited by incomplete viral suppression and emergent resistance. These findings highlight the variable effectiveness of LET and MBV in clinical practice and support the need for further research to define optimal antiviral use in SP and refractory CMV treatment.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".