Objective: Review the advantages of CMV viral load monitoring in preventing CMV associated complications in kidney transplant recipients

Methods: All individuals who underwent a kidney transplant at our center from 1/2011 to 5/2014 were included in this analysis. Patients were categorized into low, intermediate and high risk groups based on donor and recipient CMV IgG profile and presumed associated CMV risk and received 6, 12, or 24 weeks of oral valganciclovir prophylaxis, respectively. We prospectively monitored CMV PCR and adjusted valganciclovir and maintenance immunosuppression dosage at onset of CMV viremia. Oral valganciclovir was continued for a minimum of two weeks following resolution of viremia or as was clinically indicated.

Results: We identified 197 patients who underwent a kidney transplant during the stated period, of which 97 individuals received a deceased donor and 100 individuals received a living donor kidney transplant. There were 88 women and 109 men, with 85 African Americans and 77 Caucasians as the dominant racial subgroups in this cohort. Based on CMV IgG profile, 28 patients were categorized as low risk (D-/R-); 132 patients as intermediate risk (D-/R+ or D+/R+); and 37 patients as high risk (D+/R-). 37 (18.8%) patients developed CMV viremia at 161±18, 143±13, and 173±65 days after transplant in the low, intermediate and high risk groups, respectively (p=0.75). Incidence of CMV viremia for the low risk (2/28, 7.1%), intermediate risk (28/132, 21.2%), and high risk groups (7/37, 18.9%), was comparable as well (p=0.22). CMV viral load at onset of viremia was 1,595±1,834 IU/mL in the low, 627±729 IU/mL in the intermediate and 10,908±13,391 IU/mL in the high risk groups (p<0.01). Caucasians were less likely to develop CMV viremia (7/77, 9.1%) as compared to other racial groups (p<0.01). Risk of CMV viremia was not influenced by choice of antibody induction (p=0.58). None of the patients developed CMV disease or any significant clinical complication as a consequence of CMV viremia.

Conclusions: A significant number of patients developed CMV viremia in all three risk groups despite valganciclovir prophylaxis. Prospective monitoring by PCR allowed early detection of CMV viremia and intervention with reduced risk of CMV associated complications in this kidney transplant patient cohort.

CITATION INFORMATION: Gilbert A, Cooper M, Verbesey J, Ghasemian R, Abrams P, Moore J, Grafals M, Chahine J, Punnett S, Hall E, Anzak I, Javaid B. CMV Monitoring Reduces Risk of Clinical Complications in Kidney Transplant Recipients. Am J Transplant. 2016;16 (suppl 3).

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