Characterization of Cytomegalovirus (CMV) Viremia and Disease in CMV High-Risk Kidney Transplant Recipients: A Single-Center Experience

Background: Cytomegalovirus (CMV) infection in Kidney Transplant Recipients (KTRs) is associated with significant morbidity particularly in the high risk (HR) [donor positive (D+) and recipient negative (R-)] KTRs. We compared severity of CMV infection in CMV HR KTRs at our center after 6 months (mo) of valganciclovir prophylaxis (ppx) where post ppx, CMV PCR monitoring is NOT performed vs. published data where post ppx CMV PCR surveillance was done. Methods: We reviewed records of CMV HR KTRs at our center from 2019-2022, to identify the frequency and severity of CMV viremia, disease burden, hospitalizations, and mortality. We then compared our outcomes to published literature in a similar setting (IS and ppx) where CMV PCR monitoring is performed post ppx for 3 mo (PMID: 27423138). Results: Of the 71 CMV HR KTRs, induction was with Anti Thymocyte Globulin in 81%, Basiliximab in 15%, no induction in 4%. Maintenance IS consisted of Tacrolimus (T) / Mycophenolate (M) /Prednisone (P) in 52%, T/M in 38% and Belatacept (B) in 4%. 87% completed 6 months of valganciclovir. CMV viremia/infection was seen in 42%. Mean time to viremia was 224±181 days. Mean viral load was 4.43 ±1.3 log. Of those with CMV, 30% had a prior rejection episode, 90% were symptomatic, 70% required hospitalization, 17% required multiple hospitalizations and 13% had resistant CMV. All 3 KTRs on belatacept had CMV. Average length of stay per hospitalization was 12.8±10 days (total 361 hospital days). Eventually 2(6.7%) died. Treated with reduction in IS, ganciclovir or valganciclovir. Alternate therapies as Maribavir or Foscarnet was needed in 27%. Comparison with published data as shown in Table 1. Conclusion: CMV infection is associated with increased morbidity among CMV HR KTRs. Post ppx CMV PCR monitoring may help with early detection of CMV viremia which may reduce disease burden and hospitalizations. More studies are needed to establish benefit and cost effectiveness. - Study Comparison group Incidence of CMV (%) 42 40 CMV resistance rate (%) 13 15.8 Hospitalization rate in CMV (%) 70 47 Alternate therapies other than Valganciclovir/ Ganciclovir 27 5