*Purpose: Cytomegalovirus (CMV) is a common viral pathogen among kidney transplant recipients (KTRs). Although guidelines recommend the use of prophylaxis or pre-emptive antiviral (AV) therapy depending on the risk level, limited data exist on the recent national level treatment patterns of CMV antiviral agents (AV) among KTRs. We examined the real-world CMV-AV utilization patterns among adults KTRs in the United States (US) overall and by CMV serostatus of donor (D) and recipients (R).

*Methods: We utilized a retrospective cohort design using the US Renal Data System registry-linked Medicare data from January 1, 2011, through December 31, 2017. The study cohort included adults undergoing their first KT during the study period with continuous medical coverage for at least 6-month pre and 12-month post KT and pharmacy benefits coverage for at least 12-month post- KT. CMV-AV prophylaxis was defined as ≥ 1 prescription fill or medical claim for either (val)acyclovir or (val)ganciclovir (VGC) therapeutic dose within 28 days post-KT. Descriptive statistics were reported by CMV prophylaxis status by CMV risk strata (low: D-/R-; medium: R+; and high: D+/R).

*Results: The study cohort comprised of 23,445 KTRs of which 11%, 74% and 15% were at low, medium and high risk of CMV, respectively. The mean age (standard deviation, SD) of KTRs was 53.8 (13.9) years. The majority of KTRs were males (59%), Whites (59%) and African Americans (33%); received a graft from deceased donor (86%); and received induction with anti-thymocyte globulin (54%), mycophenolate (96%), tacrolimus (95%), and steroids (96%). CMV-AV prophylaxis was used by 35%, 83%, and 85% of low-, intermediate- and high-risk KTRs, respectively. Overall, valganciclovir was utilized in 98% of KTRs treated with CMV AV-prophylaxis. From 2011 to 2016, an increase in the use of VGC 900 mg in high-risk and a relatively stable trend of VGC 450 mg dose were noted in intermediate-risk KTRs. The mean duration of CMV prophylaxis was 102 (SD:70.4) days. Proportions of KTRs with duration of CMV prophylaxis ≥100 and ≥ 200 days were 50% and 11% of high-risk, and 25% and 5% of intermediate-risk KTRs, respectively.

*Conclusions: Valganciclovir was commonly utilized as CMV-AV prophylaxis. The majority of KTRs had shorter than the guideline-recommended duration of 100 or 200 days of CMV-AV prophylaxis, especially among high-risk KTRs, which may lead to suboptimal efficacy for CMV prevention.

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