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CMV prophylaxis after kidney transplant — ESENeph MCQ

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ModerateRenal TransplantationCMV prophylaxis after kidney transplantESENeph

A 47-year-old CMV-seronegative woman receives a kidney from a CMV-seropositive donor. She is treated with tacrolimus, mycophenolate and prednisolone. There is no leucopenia and eGFR is 48 mL/min/1.73 m². What is the most appropriate management?

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Correct answer: B — Valganciclovir prophylaxis with renal dose adjustment

CMV D+/R- kidney transplant recipients are high risk and usually receive valganciclovir prophylaxis adjusted for renal function. Being seronegative increases, rather than decreases, risk when the donor is seropositive. Aciclovir is not equivalent CMV prophylaxis in this high-risk setting. The pearl is that prophylaxis dosing must track graft function to avoid under-treatment or marrow toxicity.

Reference: British Transplantation Society CMV Guideline; BNF