Cytomegalovirus (CMV) Serostatus Reassessment in CMV Seronegative Kidney Transplant Candidates

Background Recipient cytomegalovirus (CMV) serostatus reassessment proximate to transplant for initially CMV seronegative patients is critical to guide post‐transplant CMV preventive strategies in kidney transplant recipients (KTR), since seroconversion during the long wait‐list time could lead to CMV serostatus misclassification. The feasibility and optimal timing of CMV serostatus reassessment and the incidence of seroconversion have not been systematically examined. Methods Program adherence to a guideline for CMV serology reassessment within 6 months of transplant among initially CMV seronegative adults undergoing a first kidney transplant between December 17, 2022 and December 17, 2024 was retrospectively assessed. The association of baseline and transplant factors with adherence was compared by chi‐square or Fisher's exact test ( p < 0.05 considered significant). The incidence of CMV seroconversion between the time of listing and transplant was calculated per person‐years of follow‐up. Results Among 823 adult KTR, 586 (71.2%) were eligible and 127 (21.7%) were CMV seronegative at listing. The median (interquartile range) time to transplant was longer for deceased (5.23 [2.86–7.44] years) than living donor KTR (1.51 [0.76–2.74] years). Program adherence was 91.3% (116/127) overall and higher among living (65/65 [100%]) versus deceased donor transplants (51/62 [82.3%]), p < 0.01). No demographic or transplant‐related variables were associated with adherence ( p > 0.05 for all variables). Seroconversion between listing and transplant occurred in two of 124 patients (1.6%), an incidence of 0.0043 per person‐year of follow‐up. Conclusion Program adherence to CMV serostatus reassessment within 6 months of transplant was high in a clinical setting and identified a low incidence of seroconversion.