Background: The rate of Cytomegalovirus infections in kidney transplant recipients drastically diminished with the advent of oral ganciclovir and subsequently valganciclovir. However it continues to be one of the most prevalent and concerning opportunistic infections in the transplant recipient. Various dosing strategies and durations have been studied and reported over the last 15 years. To our knowledge there have been no studies looking at dosing and outcomes in the obese population. With the use of robotic kidney transplantation, we have significantly increased the number of kidney transplants performed in patients with a BMI>35. Concern was raised that we may be under dosing many of these patients with our standard prophylaxis regimen.

Methods: From Jan 2009 to Nov 2013 we performed nearly 200 kidney transplants in patients with a BMI>35. These patients received our standard prophylaxis of valganciclovir 450mg daily (adjusted for GFR based on MDRD) started by POD7 and continued for 6 months after transplant for all patients except donor neg/recipient neg serostatus. CMV PCR was checked at 3, 6, 9 and 12 months after transplant or at any time of concern for CMV infection.

Results: During the timeframe 150 kidney transplant recipients had data for evaluation and a BMI>35 at time of transplant. 73 of these patients had a BMI>40. Twenty-four of 150 (16%) patients had a detectable PCR with median value of 29,127 copies (range 780-4.5 mil copies). For the patients with BMI>40, thirteen of 73 (17.8%) had a detectable PCR with a median value of 32,750 copies (range 1300-1.45mil copies). Only 6 of 150 (4.0%) patients developed viremia in the first 6 months, while 16 (10.7%) developed it in months 6-12. CMV serostatus of those who developed CMV viremia were: CMV-/+ (n=4), CMV+/+ (n=17), CMV-/+(n=3). Incidence of documented CMV disease and immunosuppression regimen for these patients is currently being reviewed. Of note our CMV viremia rate for all patients in the first 12 months after kidney transplant has previously been reported as 10.2%.

Conclusion: While this review shows a higher incidence of CMV viremia in our obese population, the incidence while on prophylaxis remains low and the majority of patients exhibited low levels of viremia. Further investigation into the patients developing viremia while on prophylaxis and the patients developing viremia in months 6-12 is warranted.

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