*Purpose: To evaluate if a preemptive therapy strategy can prevent CMV disease and induce CMV seroconversion.

*Methods: Observational data collection for CMV D+/R- adult liver transplant recipients from 11/2020-11/2021. With a pharmacist-lead protocol for monitoring and follow-up, plasma CMV viral loads (VL) were checked weekly, and treatment with oral valganciclovir was initiated once VL >100 IU/ml, using quantitative, WHO standard testing methods. Valganciclovir was reduced to prophylaxis dosing once VL was negative x2 and continued until 6 months post-transplant. Duration of treatment and prophylaxis, incidence of CMV disease (defined by the AST Infectious Diseases Community of Practice), and rate of seroconversion to CMV IgG+ was monitored.

*Results: Of 72 adult liver transplants, 25 patients were CMV D+/R-. Two were excluded for receiving antiviral prophylaxis due to clinical condition. Of the 23 remaining patients, 17 (74%) developed CMV viremia (VL >100 IU/ml) at a median of 20 days post-transplant. The median VL at treatment start was 202 IU/ml with a median peak VL of 1640 IU/ml. For the 11 patients who have completed 6 months of follow-up, 9/11 (82%) became viremic, and treatment dosing lasted a median 32 days (range 5-43 days). None of the patients experienced symptomatic disease during the first 6 months. Notably, of patients who are >6 months post- transplant, 6 of 8 (75%) have developed CMV-specific IgG antibodies. All patients received methylprednisolone induction, while 13/23 (57%) patients also received basiliximab for renal-sparing purposes, including 8/17 (47%) who became viremic. For maintenance immunosuppression all patients were on tacrolimus, and 15/23 (65%) recipients were also receiving mycophenolate, including 12/17 (71%) at the time they became viremic.

*Conclusions: Preemptive therapy for CMV D+/R- liver transplant patients is effective at preventing CMV disease and allows recipients to develop de novo CMV-specific IgG.

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