*Purpose: Valganciclovir (VGC) is the optimal agent for preventing cytomegalovirus (CMV) but its use is limited by cost and leukopenia. Reduced dose VGC (rVGC) has been utilized in moderate CMV risk patients to mitigate these risks but carries a risk of development of CMV resistance. Current guidelines don’t recommend rVGC due to lack of literature. We sought to review CMV incidence in patients receiving rVGC at our institution.

*Methods: Adult kidney transplant (KT) recipients from 8/1/14-10/31/17 were included in this retrospective study. Primary outcome was incidence of CMV. Patients that developed CMV were compared to randomly selected patients that didn’t develop CMV. Secondary outcomes included incidence of biopsy-proven acute rejection (BPAR), graft and patient survival 12 months post-KT.

*Results: Of 267 KT patients from 8/1/14-10/31/17, 34 (12.7%) developed CMV viremia. Of these, 14 were asymptomatic, 13 had viral syndrome, and 7 developed tissue invasive CMV. 15 patients were high and 18 were moderate CMV risk. Three patients in the high CMV risk group received an inappropriate dose of VGC based on renal function (Figure), two of which developed CMV viremia. CMV developed on average 6.6 months post-KT. Patients with tissue invasive CMV developed CMV 7.6 months post-KT. There were no episodes of CMV resistance. Baseline demographics are in Table 1. No significant differences were seen in tacrolimus levels between groups at 1, 3, and 6 months post-KT. No significant differences in incidence of BPAR (14.7% vs 11.7%, p=1), graft survival (100% vs 91%, p=0.23), or patient survival (100% vs 100%, p=1) were seen. There was a higher incidence of CMV viremia in patients who continued on steroids post-KT rather than early steroid withdrawal (57.5% vs 39.3%), although not significant (p=0.22).

*Conclusions: Moderate risk patients receiving rVGC do not appear to be at an increased risk of CMV viremia. There does not appear to be an increased risk of CMV resistance development. Steroid withdrawal may be protective in reducing the risk of CMV viremia. Future studies need to be performed to further evaluate the impact of steroid withdrawal on CMV.

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