*Purpose: Cytomegalovirus (CMV) poses significant risks and complications in solid organ transplant (SOT) patients. The current CMV guidelines acknowledge CMV serologic mismatch transplants contribute to higher risk of CMV infection and disease, but make no formal recommendation on seromatching donors and recipients. Furthermore, current data provide conflicting results on the practice of CMV seromatching. The purpose of this study is to assess 1-year survival rates among the different CMV serostatus donor/recipient groups in lung transplant patients. The results from this study may add to the literature regarding the practice of CMV seromatching in SOT recipients and ultimately guide organ allocation.

*Methods: A single center retrospective, observational chart review was performed in patients receiving a lung transplant between January 2012 and October 2017. The primary endpoint was 1-year survival rates between each of the four CMV seromatching groups (D-/R-, D-/R+, D+, R+, and D+/R-). Secondary outcomes included incidence of acute cellular rejection (ACR) and CMV infection. Patients were excluded if they were <18 years old, had a multi-organ transplant, or an unknown CMV serologic status.

*Results: A total of 125 patients were included. Among the 4 serogroups, D-/R- (n=14), D-/R+ (n=18), D+/R+ (n=69) and D+/R- (n=18). Of all patients, 65% were male, 48% were Caucasian, 32.8% received a lung transplant due to interstitial pulmonary fibrosis, average ischemic time was 245 minutes and average panel reactive antibody (PRA) I was 9.6% and average PRA II was 5.1%. The highest incidence of mortality occured in the D+/R+ CMV serogroup (n=5, 7%) (p=0.2). Notably the high risk, D+/R-, CMV serogroup had the highest incidence of ACR (n=13, 54.2%) (p=0.2) and CMV infection (n=5, 20.8%) (p=0.2) within the 1^st year post-transplant. Additionally, comparing the moderate risk, D-/R+ and D+/R+, groups did not yield statistically significant differences in the primary or secondary outcomes. Most commonly, valganciclovir was used for CMV prophylaxis except in low risk, D-/R- patients.

*Conclusions: This study showed 1-year patient survival was 96% irrespective of CMV donor-recipient serostatus. Higher rates of ACR and CMV infection were observed in the high risk, D+/R-, group, but these findings may be influenced by confounding variables. Since statistical significance was not seen, these data may not support the practice of CMV seromatching in lung transplant patients.

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