*Purpose: The incidence of cytomegalovirus (CMV) remains high in the first year following kidney transplantation. Valganciclovir (VGC) is commonly prescribed in the early post-operative period in order to prevent complications related to CMV. Outcomes in kidney transplant recipients experiencing delayed graft function (DGF) on hemodialysis (HD) receiving a renally dose adjusted regimen of VGC remains unknown.

*Methods: This is a single-center, retrospective review of of CMV viremia among deceased donor kidney transplant (DDKT) recipients with DGF requiring hemodialysis (HD) receiving VGC 450 mg twice weekly compared to patients with immediate graft function (IGF) who received initial daily VGC prophylaxis following transplant. The primary endpoint was the rate of CMV viremia during the first 12 months post-transplant. Secondary outcomes included the time from transplant to CMV viremia and the time from completion of prophylaxis to CMV viremia. Data analysis was performed using SPSS Statistics Software (Chicago, IL; version 25).

*Results: CMV viremia occurred while on prophylactic VGC at a median of 68 days (65-70) in 2 patients in the DGF group and in no patients in the IGF group. After completing prophylactic therapy, CMV viremia occurred in 30 DGF patients and 10 IGF patients (42% vs. 33%, p=0.43). In the DGF group and the IGF group, the median time to CMV positivity from transplant was 210 days (155-262) and 260 days (221-297), respectively. The median time to CMV positivity from prophylaxis therapy completion was 71 days (42-162) in the DGF group and 126 days (42-205) in the IGF group. One patient in the DGF group developed VGC-resistant CMV confirmed by genotype testing. Univariate analysis demonstrated that age >60, lymphopenia at the end of therapy and induction with anti-thymocyte globulin were associated with the development of CMV.

*Conclusions: There were similar rates of CMV viremia in DGF DDKT recipients as compared to those with IGF, regardless of CMV risk status. Larger studies are warranted to further explore whether a difference exists when renal adjusted VCG is used.

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