Comparison of Two Strategies for Preventing Cytomegalovirus Disease in Solid Organ Transplant Recipients
Shaúl Ariel Navarro‐Lara, Juan José Calva‐Mercado, Tomas Rafael Mercado‐Torres, Mariana Vélez‐Pintado, Bernardo Alfonso Martínez‐Guerra, Carla Marina Román‐Montes, Sandra Rajme‐López, Ever Arturo Corral‐Herrera, Héctor Orlando Rivera‐Villegas, Nayelli Cointa Flores‐García, Luis Eduardo Morales‐Buenrostro, María Fernanda González‐Lara, Karla María Tamez‐TorresABSTRACT
Background
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.
Methods
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).
Results
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).
Conclusion
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.