Optimal cytomegalovirus(CMV) prevention strategy following solid organ transplantation(SOT) is uncertain. We report on CMV disease with implementation of prophylaxis-based prevention with intensive monitoring.

We retrospectively evaluated the incidence of CMV events(asymptomatic infection/syndrome/disease) after implementation of an evidence-based CMV prevention guideline. Outcomes were recorded from 9/2013-10/2017.

173 pediatric SOT were performed. 37(21%) recipients had CMV events: 22 asymptomatic, 14 syndrome and 1 disease (hepatitis in liver recipient at 121d). Median time to 1^st CMV event was 166d(IQR 29-226d). Asymptomatic events occurred during <30, 30-120 and >120d in 9/10, 1/2 and 12/25 CMV events, respectively. After 3 asymptomatic <30d in hearts, prophylaxis dosing was increased for the first 3 weeks with no subsequent events. One liver had asymptomatic CMV at <30d with misclassification of D/R status. Two asymptomatic infections and 1 syndrome occurred with deviations. Kidneys developed CMV only after prophylaxis ended in 6/67(9%). In a similar period(>120d), hearts and livers had 5/36(14%) and 13/70(18%) with scheduled screening.

Invasive end-organ CMV disease is rare with prophylaxis/monitoring. Increased screening resulted in identification of asymptomatic infections, especially early post-transplant. Scheduled screening increased prevalence of late events (heart/liver) and led to early prophylaxis dose change (heart), highlighting its utility.

Table1: CMV by SOT, serostatus, time of 1^st event.

CITATION INFORMATION: Pangonis S., Miethke A., Flores F., Schecter M., Kocoshis S., Lazear D., Hemmelgam T., Taylor B., Paulsen G., Danziger-Isakov L. Evaluation of a Change in CMV Prevention Strategy Following Pediatric SOT Am J Transplant. 2017;17 (suppl 3).

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