CLINICAL MANAGEMENT AND BURDEN OF CYTOMEGALOVIRUS IN D+/R-KIDNEY TRANSPLANT RECIPIENTS IN CANADA

John Gill¹Andrew House^2,3Zain Chagala⁴Jean Tchervenkov⁵S. Joseph Kim⁶Amanda Vinson⁷Carlos Cervera⁸Paul Keown^1*Sonia Lai Wing Sun⁹Christina Khoury^10,9Christiane Ghakis⁹

• ¹Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
• ²Western University, London, Ontario, Canada
• ³Department of Medicine, Western University, London, Canada, London, Canada
• ⁴Department of Medicine, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
• ⁵Department of Surgery, McGill University Health Centre, Montreal, Quebec, Canada
• ⁶Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
• ⁷Department of Medicine, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
• ⁸Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
• ⁹Merck, Canada, Inc., Kirkland, QC., Canada
• ¹⁰Merck, Kirkland, QC, Canada

Purpose: To document prophylactic practices, infection patterns, and disease burden to inform strategies for CMV management in high-risk kidney transplant recipients. Methods: A retrospective cohort of 311 consecutive CMV D+/R- kidney recipients were enrolled from 7 Canadian programs over 4 years (2018-2021) to provide data on demographic, clinical, therapeutic and health resource use during the 1st year post-transplant. Results: The meanmedian age was 58 (46, 67) 52 ± 14 years, 69% were male, and 53% were White. Diabetes was the principal cause of kidney failure (19%). 208 (69%) received a deceased donor graft; 76 (24%) had ATG induction, and 84% had maintenance therapy with tacrolimus and MMF/MPA ± prednisone. All received antiviral prophylaxis, 90% with valganciclovir, for a median of 180 days. 106 (34%) developed CMV viremia (median peak viral load 14,224 IU/ml) at a median of 218 days, of whom 46 (43%) had CMV disease and 15 (14%) had recurrent infection. Myelotoxicity occurred in 121 (39%) patients at a median of 88 days, lasting a median of 30 days. Opportunistic infections occurred in 119 patients (38%) at a median of 53 days. 141 patients (45%) were hospitalized, 50 (16%) more than once. 20 patients (6%) had biopsy-confirmed rejection, and 293 (94%) were alive with a functioning graft at 1 year. Conclusion: Current prophylaxis strategies fail to prevent CMV infection in 34% of high-risk patients. Myelotoxicity, opportunistic infection, reduced immunosuppression, and hospitalization remain common and serious complications. More effective and less toxic personalized treatment strategies are required to minimize these risks and burdens.