*Purpose: This study evaluates if choice and duration of Cytomegalovirus (CMV) prophylaxis based on donor (D) and recipient (R) CMV serostatus impacts the incidence of post-transplant CMV viremia in low (D-/R-) and intermediate (R+) risk kidney transplant recipients (KTR) receiving lymphocyte-depleting induction therapy.

*Methods: Adult D-/R- and R+ KTR receiving anti-thymocyte globulin [rabbit] (rATG) or alemtuzumab induction at our institution from 8/20/16-9/30/18 were evaluated through 1 year post-transplant. Patients were excluded if they were CMV D+/R-, received a multi-organ transplant, or received basiliximab. Historically, this population received 6 months of valganciclovir (pre-intervention group). After an institutional practice change, D-/R- patients received valacyclovir for 3 months and R+ patients received valganciclovir for 3 months (post-intervention group). Fisher’s exact test was used to compare categorical data and the Student’s t or Mann-Whitney U test was used for continuous data. Statistical significance was set at α=0.05.

*Results: Baseline characteristics are described in Table 1 (D-/R- n=25, R+ n=52). No D-/R- patients experienced CMV viremia. Among the R+ pre- and post- groups, there was no significant difference in viremia incidence (41.9% vs. 52.4%, p=0.573; Table 2) nor the initial viral load (median, IQR; <50, <50-91 vs. <50, <50-217; p=0.865; Table 2). Neither group showed a significant difference in the incidence of leukopenia or neutropenia (LN); however, a trend toward increased incidence was seen in the D-/R- pre- compared to the post- group (75.0% vs 23.4%, p=0.081; Table 2). No D-/R- patients experienced rejection. Seven R+ patients experienced rejection in the pre- group and one in the post- group (p=0.122).

*Conclusions: A similar incidence in CMV viremia between the pre- and post-intervention groups suggests a more aggressive CMV prophylaxis may not be necessary in low and intermediate risk KTR receiving rATG or alemtuzumab . The trends toward reduced incidence of LN and rejection in the post- groups suggest potential benefits in limiting valganciclovir exposure.

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