Cytomegalovirus Post‐Prophylaxis Surveillance in High‐Risk Kidney and Liver Recipients Prevents CMV End‐Organ Disease and Ganciclovir‐Resistance

ABSTRACT Purpose Evaluate cytomegalovirus (CMV) post‐prophylaxis surveillance in high‐risk (D+/R‐) kidney and liver transplant recipients. Methods Adult D+/R‐ patients were included if transplanted between 6/1/15 and 11/30/22 and divided into a pre‐CMV‐stewardship‐era (6/1/15–5/31/18), CMV‐stewardship‐era (6/1/18–6/30/20), and a surveillance‐era (7/1/2020–11/30/2022) then followed through 12 months. The primary objective was to evaluate CMV‐related outcomes. The secondary objective was to assess graft and patient survival by era. Results There were 328 patients in the study period; 133 in the pre‐stewardship‐era, 103 in the stewardship‐era, and 92 in the surveillance‐era. Replication rates in the surveillance‐era were significantly higher, as anticipated due to increased sampling (pre 38.4%, stewardship 33.0%, surveillance 52.2%, p = 0.02). Time from transplant to first replication was similar (pre 214.0 ± 79.0 days, stewardship 231.1 ± 65.5, surveillance 234.9 ± 61.4, p = 0.29). CMV viral load (VL) at first detection, maximum‐VL, and incidence of VL > 100 000 IU/mL were numerically lower in the surveillance era, although not statistically significant. CMV end‐organ disease ( p < 0.0001) and ganciclovir‐resistance ( p = 0.002) were significantly lower in the surveillance era than in both previous eras. Rejection was not different between eras ( p = 0.4). Graft ( p = 0.0007) and patient survival ( p = 0.008) were significantly improved in the surveillance era. Conclusions Post‐prophylaxis surveillance significantly reduced CMV end‐organ disease and resistance. Despite observing increased replication rates in the surveillance era, rejection was not significantly different and there was no graft loss or patient mortality at 12 months.