*Purpose: Kidney transplant recipients with high-risk cytomegalovirus (CMV) serostatus are at risk for late onset CMV after cessation of antiviral prophylaxis.^1-2 Evidence for post-prophylactic viral monitoring are inconclusive³. Previously, we previously showed using Markov modeling that screening for CMV viremia every 2 weeks would be cost-effective compared to no screening or screening weekly.¹⁵ We report findings from a single center regarding a strategy of bimonthly (every 2 weeks) screening for CMV viremia for 6 months after stopping prophylaxis.

*Methods: Observational retrospective cohort study of 70 CMV high-risk (Donor CMV IgG positive to recipient CMV IgG negative) kidney transplant recipients transplanted at the University of Pittsburgh Medical Center between June 2016-September 2018 who were monitored for late onset CMV with every 2 week CMV nucleic acid testing (NAT). Data pertaining to demographics and transplant characteristics, CMV episodes (viremia, hospitalization, complications) and compliance with CMV testing was obtained from the electronic health record. We analyzed factors associated with development of severe CMV (defined as CMV viremia >50,000 International Units/milliliter and/or CMV related hospitalization) and categorized screening failure into three categories (non-compliance to CMV testing, rapid CMV progressors and system failure). We also compared hospitalization rates to the hospitalization rates for varying degree of compliance with CMV screening as predicted by the previously constructed Markov model.

*Results: Based from our data, the incidence of CMV viremia was 30% and the rate of hospitalization related to CMV disease among those who had viremia was lower at 47%, which was lower compare to our pre bimonthly surveillance rate. We evaluated factors that would cause failure of the surveillance strategy. Of the patients with severe CMV infection 45.5 % (5/11) were found to be non-adherent to bimonthly CMV testing. Thirty six percent (4/11) were considered rapid progressors. The initial positive viral load ranged from 35,800 – 236,346IU/mL. The remaining 18.2% (2/11) was found to be related to system failure. Based from our modeling, CMV rate is 47% among those with patients with 40% adherence to surveillance. The above mentioned rates are consistent with our study results. There was an expected rate of 20% severe CMV even on 100% adherence to surveillance.

*Conclusions: Bimonthly screening allows for early detection and treatment of late onset CMV infection. There was a decreased rate in CMV related hospitalization compare to our pre bimonthly screening data. The main barrier identified to surveillance failure is non-adherence to testing.

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