Despite therapeutic advancements, the incidence of refractory or resistant CMV in post-transplant patients remains a challenge1

US Incidence of refractory or resistant CMV in SOT and HCT recipients1

 Refractory CMVResistant CMV
SOT recipientsUp to
Up to
HCT recipientsUp to
Up to

Data from a 2020 Takeda systematic review of 86 observational (non-interventional) studies in the US and Europe.

Many factors may be associated with an increased risk of developing refractory or resistant CMV post-transplant3-6

Risk factor chart

HLA=human leukocyte antigen.

*HCT only.
SOT only.

The incidence of post-transplant refractory or resistant CMV, along with the significant and multifaceted risk factors, illustrate some of the current challenges these patients face.

Learn more about a treatment option in post-transplant refractory or resistant CMV.7

1. Data on file. Takeda Pharmaceuticals U.S.A., Inc. 2. Chemaly RF, Chou S, Einsele H, et al. Clin Infect Dis. 2019;68(8):1420-1426. 3. El Chaer F, Shah DP, Chemaly RF. Blood. 2016;128:2624-2636. 4. Fisher CE, Knudsen JL, Lease ED, et al. Clin Infect Dis. 2017;65(1):57-63. 5. Sandkovsky U, Qiu F, Kalil AC, et al. Transplant Proc. 2018;50(10):3763-3768. 6. Liu J, Kong J, Chang YJ, et al. Clin Microbiol Infect. 2015;21(12):1121.e9-15. 7. Livtencity (maribavir) Prescribing Information. Lexington, MA: Takeda Pharmaceuticals U.S.A., Inc.

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About the data

Data from a 2020 systematic review of observational (non-interventional) studies in the US and Europe. Takeda conducted a study using methods proposed by the Cochrane Group and the Institute of Medicine of the National Academy of Medicine. Abstract screening was conducted independently by two reviewers and discrepancies were resolved by a third reviewer. Overall, 86 studies were included in the systematic review. The majority of studies were retrospective cohort analyses (n=75).1

Summary of studies included in this systematic review1:

Patient typeStudy population sizeTiming of assessment

SOT recipients

Patient typeRefractory CMV
Study population size100 to 500 patients (2 studies)
Timing of assessment≥1 year post-transplant (2 studies)
Patient typeResistant CMV
Study population size≤100 patients (3 studies)
100 to 500 patients (6 studies)
Timing of assessmentUnknown (4 studies)
≥1 year post-transplant (5 studies)

HCT recipients

Patient typeRefractory CMV
Study population size≤100 patients (2 studies)
Timing of assessment≤100 days post-transplant (2 studies)
Patient typeResistant CMV
Study population size≤100 patients (1 study)
100 to 500 patients (7 studies)
Timing of assessmentDuring follow-up, variable time period (2 studies)
≤100 days post-transplant (2 studies)
>100 days <1 year post-transplant (1 study)
≥1 year post-transplant (3 studies)

Consensus definitions of refractory or resistant CMV

Refractory or resistant CMV is typically diagnosed after failure to respond to 2 weeks of appropriate antiviral therapy1

Probable refractory CMV infection2:

  • Persistent viral load after at least 2 weeks of appropriately dosed antiviral therapy
  • CMV viral load at the same level or higher than the peak viral load within 1 week but <1 log10  increase in CMV DNA titers done in the same laboratory and with the same assay

Definite Refractory CMV infection1,2:

  • Increase in CMV DNA or failure to achieve decrease in CMV DNA level (>1 log10) in whole blood or plasma after 2 or more weeks of treatment with appropriately dosed antiviral therapy
  • May occur in the presence or absence of an identified mutation

Resistant CMV infection2:

  • Confirmation of an alteration in the viral genetic sequence that decreases susceptibility to 1 or more antiviral CMV treatments
  • Must also meet the definition of refractory CMV infection