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CMV Prophylaxis Post-Transplant — ESENeph MCQ

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ModerateTransplantationCMV Prophylaxis Post-TransplantESENeph

A 52-year-old man undergoes a kidney transplant. Pre-transplant serology shows Donor CMV IgG positive, Recipient CMV IgG negative (D+/R-). What prophylactic strategy is recommended?

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Correct answer: D — Valganciclovir prophylaxis for at least 200 days (6 months)

D+/R- is the highest risk combination for CMV disease post-transplant. KDIGO 2009 transplant guideline and international CMV consensus recommend either prophylaxis or pre-emptive monitoring. For D+/R- recipients, valganciclovir prophylaxis for at least 200 days (approximately 6 months) is recommended, as the VICTOR study showed that 200 days is superior to 100 days in reducing late-onset CMV disease. Aciclovir has no activity against CMV.

Reference: KDIGO 2009 – Transplant Guideline; Kotton et al 2018 – CMV Consensus