*Purpose: We sought to compare outcomes of cytomegalovirus (CMV) prophylaxis in high risk CMV (donor +/recipient -) kidney and pancreas transplant recipients who received different valganciclovir (VGC) renal dosing strategies and experienced delayed graft function (DGF) or had immediate graft function (IGF).

*Methods: This retrospective, single-center cohort review screened all high risk CMV kidney and kidney-pancreas (SPK) transplants from January 1, 2015 through May 1, 2020. Patients were excluded if they did not receive induction with rabbit anti-thymocyte globulin (rATG), required dialysis post-transplant solely for hyperkalemia, or received a prior non-kidney solid organ transplant. Patients received induction with rATG (1.5 – 6 mg/kg), standard triple maintenance immunosuppression, and CMV prophylaxis with VGC. 6-month follow up was completed and 1-year outcomes reported as able.

*Results: Baseline characteristics were well-balanced between cohorts with exception to age. No significant differences in rejection or graft loss were observed between transplant recipients with or without DGF. However, resistant CMV, CMV viremia, and death occurred at a higher rate in the DGF cohort. No significant differences were seen among patients with DGF on differing VGC regimens.

Table 1. Baseline Characteristics

Table 2. CMV Incidence and Transplant Outcomes

Table 3. VGC Dosing Outcomes

*Conclusions: Our data suggests that incidence of CMV viremia, CMV resistance, and all-cause death are higher in patients with DGF, but that outcomes are similar between different VGC dosing strategies employed in DGF.

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