*Purpose: The main objective of the study is to compare the efficacy of the different Valganciclovir dosing strategies in pediatric solid organ transplant recipients with safety evaluated as a secondary endpoint.

*Methods: This is a retrospective cohort study of all pediatric patients who underwent kidney or liver transplantation at King Faisal Specialist Hospital and Research Centre and received VGC as CMV prophylaxis between 2010 and 2018. Subjects aged 14 years or less were included. The primary goal is to compare the incidence of CMV infection between the three dosing regimens.

*Results: One hundred and fifty patients were included; 50 patients in each dosing group. Patient’s characteristics were similar amongst the groups except for the CMV donor/recipient status, who were present in 8 out of the 50 patients in the equation-based regimen (16%) versus none in the other two groups. Overall, CMV infection was significantly higher in patients who received BSA-based regimen 26 out of 50 (52%) vs. equation-based regimen 22 out of 50 (44%) vs. weight-based regimen 12 out of 50 (24%). Of those, CMV disease occurred in 14 of 26 (53.85%) in BSA-based regimen vs 6 out of 22 (27.27%) in equation-based regimen vs 6 out of 12 (50%) in weight-based regimen

*Conclusions: Weight-based regimen was more effective in preventing CMV infection. However, prophylaxis duration differed greatly between the groups, as well as the higher number of mismatched recipients in the equation-based group; both of these factors could have contributed to the findings. Further analysis is needed to confirm the findings.

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