*Purpose: CMV infection is a major infectious complication in pancreas transplant recipients (PTR). Incidence of CMV viremia in PTR with thymoglobulin induction and it’s effect on graft survival is not well studied. Here, we aim to review the incidence and outcomes of CMV viremia in this patient population.

*Methods: A single-center, retrospective analysis of 39 PTR [including simultaneous kidney pancreas (SPK), pancreas only, pancreas after kidney or kidney after pancreas] between November 2016- April 2021 with thymoglobulin induction (6 mg/kg) with ≥8 months of follow-up (excluding one PTR due to death from postoperative complications). PTRs were on tacrolimus, mycophenolate +/- steroids for maintenance immunosuppression (IS) and one on azathioprine instead of mycophenolate. For CMV prophylaxis, valganciclovir was prescribed for 180 days in high-risk serostatus (donor- positive/recipient-negative; D+/R-), 90 days for moderate-risk (D -/R + or D+/ R+) and 30 days for low-risk (D-/ R-) per our institution’s protocol. Management of CMV viremia included reducing IS, oral valganciclovir or intravenous ganciclovir depending on the titers, response, and presence of CMV disease. Foscarnet and/ or cytogam were used in 2/9 patients based on their response to standard treatment.

*Results: CMV viremia was reported in 9/38 (23%) PTRs, all of which occurred in the first year post-transplant and all were SPK PTRs. 8/9 (88%) were in the CMV high-risk serostatus group. Pancreas allograft rejection or failure (according to UNOS definition) was not reported in CMV infected PTRs compared to two in non-infected PTRs. CMV infection did not result in a severe clinical course (ICU admission or death). Age, gender, race, antigen mismatch or pancreas donor risk index (PDRI) did not affect the incidence of CMV infection, but higher cold-ischemic time was noted in viremic group. Steroids as part of maintenance IS, did not affect incidence of CMV viremia either. We noted 2/9 CMV infected PTRs had post-transplant diabetes (defined as initiation of oral hypoglycemic agents or insulin< 0.5 u/kg/day) compared to none in non-infected group.

*Conclusions: Our study suggests higher CMV incidence in the first year post-transplant and in the SPK group. CMV viremia in PTR did not affect patient or graft survival, however, higher rates of PTD were noted in the viremic group. In our experience, most patients can be successfully treated with decreased immunosuppression and PO valganciclovir or IV ganciclovir.

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