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

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.

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.

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.

Program adherence to CMV serostatus reassessment within 6 months of transplant was high in a clinical setting and identified a low incidence of seroconversion.