*Purpose: In response to high cytomegalovirus (CMV) infection and increasing ganciclovir (GCV)-resistance rate, a pharmacist-led multidisciplinary task force was created to manage CMV prophylaxis (ppx). Herein, we report on the impact of this intervention and highlight the opportunity to utilize this approach in other high-value post-transplant (txp) monitoring.

*Methods: After a series of GCV-resistant CMV infections, a Quality Assessment and Process Improvement (QAPI) task force was formed comprised of txp nephrologist, surgeon, coordinator, quality analyst, and led by clinical txp pharmacists. Goals of task force were to quantify CMV infections, understand predisposing factors, suggest practical solutions, and update the CMV ppx protocol. The key members met twice monthly to review utility, discuss difficult cases, and optimize workflows. Parameters of success were defined as decreasing delay in valganciclovir (VGC) dose adjustment for improved kidney function to less than 4 days and management of neutropenia with continued VGC therapy.

*Results: Baseline center data was established by retrospective review of 333 kidney and pancreas recipients at high or intermediate risk for CMV. The rate of CMV infection was 39% in CMV high risk group. Patients at highest risk were CMV high risk, delayed graft function, and those with neutropenia post-txp. The CMV ppx protocol was updated to define monitoring and dose adjustment of VGC and included neutropenia management. QAPI team created an EMR derived report with key variables for the pharmacist to review twice weekly and created a dashboard for tracking.

Prospective review by the pharmacist team started in September 2020. At this time, 64% of patient were on appropriate VGC ppx dose. In total, 2,479 chart reviews performed for 73 patients over 13 months. The mean percent of patients on goal CMV ppx is now consistently over 85%. Of charts reviewed, only six (<1%) reviews found a delay greater than 4 days for renal dose adjustment, 110 (4.4%) revealed VGC dose held, and one case of GCV-resistance associated with non-adherence. A high success rate of granulocyte stimulating agents and letermovir use in appropriate cases was also achieved.

*Conclusions: Pharmacist-led QAPI CMV task force increased CMV ppx protocol adherence. This approach was well received by the txp team and additional task forces have been established based on this model. Our report demonstrated that a proactive and systematic method of tackling a high-value post-txp problem is effective and pharmacists play an important role in bringing these to fruition.

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