Comparison of Two Strategies for Preventing Cytomegalovirus Disease in Solid Organ Transplant Recipients

Cytomegalovirus (CMV) remains a major cause of morbidity in solid organ transplant (SOT) recipients. While universal prophylaxis and preemptive therapy (PET) are standard strategies, comparative data in Latin American populations-characterized by high CMV seroprevalence-are limited.

We conducted a retrospective cohort study of 731 adult recipients (2016-2024). Patients were stratified into intermediate (R+) or high-risk (D+/R- or thymoglobulin induction) groups. The primary outcome was proven CMV disease at 12 months. Bias was addressed using Inverse Probability Weighting (IPW).

Of 731 transplants, 311 were high-risk and 420 intermediate-risk. No significant difference was observed in CMV disease incidence between PET (1.9%) and prophylaxis (2.4%) (p = 0.943). IPW confirmed no association between the strategy and CMV infection (OR: 1.21; 95% CI: 0.25-5.57; p = 0.810). Notably, the absence of lymphopenia at 1 month posttransplantation was found to be protective against CMV disease (p < 0.001).

Both strategies were associated with a low incidence of CMV disease. A DNAemia threshold of 4000 IU/mL for PET proved safe across all risk strata. Early absolute lymphocyte count > 1000 cells/µL is a strong predictor of protection against CMV disease.