Maribavir for the Management of a Complex Cytomegalovirus (CMV) Infection After Liver Transplantation: Refractoriness and Intolerance to Standard Therapies in the Intensive Care Unit.

Managing cytomegalovirus (CMV) infection in the post-transplant setting is frequently complicated by severe adverse effects from standard antiviral therapy or viral resistance. We report the cases of two critically ill liver transplant recipients in whom maribavir, a kinase inhibitor approved for refractory/resistant CMV, was used. In the first case, maribavir achieved rapid viral suppression in a 30-year-old patient with refractory CMV infection. In the second case, it served as effective salvage therapy, enabling bone marrow recovery following valganciclovir-induced toxicity while maintaining viral control.  Although both patients ultimately succumbed to non-CMV-related ICU complications, maribavir demonstrated clinical utility in achieving virological control, providing a crucial alternative for complex cases where conventional options are limited.