Cytomegalovirus (CMV) infection is a major cause of morbidity, mortality, and shortened graft survival in kidney transplant recipients. Efforts to prevent CMV infection have traditionally been directed after transplantation with the use of antiviral prophylaxis, which can lead to adverse effects and increased costs. Alternatively, a pre transplant allocation strategy by matching deceased kidney donors and recipients by CMV serostatus may reduce CMV infection, graft loss, medication adverse effects, and costs associated with therapy. We adopted a CMV matching allocation policy at the centers served by our OPO beginning 08/01/2012. In this retrospective analysis of 356 (197 pre CMV allocation intervention; 159 post CMV allocation intervention) deceased donor kidney transplant recipients, CMV viremia was reduced from 14.2% (n=28) to 6.3% (n=10) (P = 0.0165) after implementing CMV matching. The percent of patients requiring antiviral treatment for CMV decreased from 11.2% (n=22) to 5.7% (n=9) (P = 0.0682). CMV matching decreased the number of high CMV risk (donor seropositive / recipient seronegative) transplants and increased the number of low CMV risk (donor seronegative / recipient seronegative) transplants. In a randomly sampled comparison between 10 high CMV risk transplants versus 10 low CMV risk transplants, the costs associated with antiviral therapy were compared. The median cost associated with antiviral prophylaxis and therapy in high risk transplants was $27,173, whereas median cost of antiviral prophhylaxis and therapy in low risk transplants was $16. CMV matching optimizes high and low risk CMV profiles and has the potential to significantly improve CMV related morbidity and mortality, promote graft survival, and significantly reduce costs associated with treatment.

CITATION INFORMATION: Lockridge J, Langewisch E, Basuli D, Olyaei A, Shaut C, Norman D. Kidney Transplant Allocation with CMV Matching Reduces CMV Infection and Related Costs. Am J Transplant. 2017;17 (suppl 3).

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