Effective suppression of drug-resistant CMV infection post-renal transplant with CMV immunoglobulin

We present an unusual case of serial CMV antiviral drug resistance first to ganciclovir (GCV) and then to maribavir (MBV) in a D +/R- CMV renal transplant patient, who received standard post-transplant valganciclovir (vGCV) prophylaxis, but developed breakthrough CMV drug resistance during this post-transplant prophylaxis period. Eventually the CMV levels were brought under control by CMV IVIG, which also adds to the relatively scarce data around this immuno-therapeutic intervention.