*Purpose: The current cytomegalovirus (CMV) guidelines in solid organ transplantation recommend chemoprophylaxis (ppx) in post-kidney transplantation recipients. This approach has led to a reduction in the incidence of CMV infection or disease (CMVdi) post-transplantation. We aimed to evaluate the efficacy of CMV ppx and the timing of CMV seroconversion (to positive IgG) post-transplantation.

*Methods: We performed a retrospective chart review of kidney and/or pancreas transplantation recipients from January 1, 2014, to December 31, 2016. We categorized patients according to their CMVdi risk (high [D+/R-], intermediate [R+], and low [D-/R-]). Data regarding ppx duration, CMV seroconversion, CMV viral load, and CMVdi was collected. Our institutional review board approved our study.

*Results: We identified 210 kidney and/or pancreas recipients during the study period. Patients received 6 months and 3 months of valganciclovir (or ganciclovir) based on high risk or intermediate risk for CMVdi, respectively. CMVdi occurred in 46/210 patients. Of those 30 patients (7 high and 23 intermediate risk, p= 0.12) developed CMVdi at a median of 12 weeks (IQR, 8-28) after discontinuation of ppx. 29 patients had only viremia, two patients had CMV colitis, and 15 had CMV disease other than colitis. The median CMV viral load was 1653 (IQR, 597 – 20725) IU/mL.

In high risk group, the median for CMVdi was 195 days (IQR 83.5-249) with a reported 405 days to seroconversion (IQR, 198 – 452), p=0.43. CMV IgG seroconversion occurred in half of the tested high-risk group, and the majority (9/11) had documented CMVdi (p=0.009). CMVdi in intermediate risk group developed at a median of 186.5 days (IQR, 109-304.5). CMVdi occurred in 27/141 intermediate risk group and 16/35 high risk group, p=0.001.

All of the patients in the high-risk group who developed CMVdi received 6 months of ppx, except two patients who received ppx for less than 3 months with one of them developing colitis.

*Conclusions: CMV ppx has reduced the incidence of CMVdi. In our study, we found that CMVdi is still a recognizable problem post-transplantation. While the majority of high risk group developed CMVdi during ppx, intermediate risk group developed CMVdi post-prophylaxis. Additionally, in most cases, CMV antibody seroconversion was associated with documented CMVdi.

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