2026 Eastern States Conference

Abstract Title 

Evaluating CMV Management in Solid Organ Transplant Recipients: A Step Toward Stewardship 

Authors’ Names
Ivanna Gomez Padilla, PharmD; Sara Lee, PharmD, BCID; Ian Booth, PharmD, BCTXP, Bailey Conkey, PharmD 

Learning Objective 
To characterize CMV management and outcomes in solid organ transplant recipients at the University of Maryland Medical Center

Background/Objective 
Cytomegalovirus (CMV) infection remains one of the most common opportunistic infections and a major cause of morbidity and mortality in solid organ transplant (SOT) recipients. First-line therapies for CMV treatment are associated with clinically significant toxicities, including myelosuppression and nephrotoxicity, which may necessitate dose reductions or treatment interruptions and increase the risk of breakthrough infection and antiviral resistance. Management of CMV in this population is complex and variable among providers, contributing to inconsistent care. This study aimed to characterize CMV management practices and evaluate associated clinical outcomes among adult SOT recipients treated at the University of Maryland Medical Center (UMMC), including both inpatient and outpatient transplant clinic settings, with the goal of supporting the implementation of a pharmacist-led CMV stewardship clinic. 

Methods 
A retrospective chart review was conducted including 163 adult SOT recipients with CMV infection treated between July 1, 2021, and June 30, 2025. Eligible patients had CMV DNAemia identified by blood polymerase chain reaction testing, defined as a viral load >1,000 IU/mL, or >500 IU/mL in high-risk patients (donor seropositive/recipient seronegative; D+/R−), and received CMV treatment. Patients were excluded if they underwent hematopoietic stem cells, did not meet criteria for CMV DNAemia., or did not receive CMV treatment. The primary outcome was the incidence of CMV-related hospitalization.  

Results 
Median CMV treatment duration was 47 days (IQR 29–77) and did not significantly differ between risk groups (p=0.27). High-risk (D+/R−) recipients demonstrated a significantly longer time to CMV viral clearance compared to intermediate-risk (R+) recipients (35 vs 29 days, p=0.017). Valganciclovir was the predominant agent used for secondary prophylaxis, with hematologic toxicity representing the primary reason for antiviral modification. Drug-resistant CMV and breakthrough CMV occurred in 4.5% and 11.7% of patients, respectively.

Conclusions 
High-risk CMV serostatus was associated with delayed viral clearance, highlighting the complexity of CMV management in solid organ transplant recipients. Broad variability in treatment duration and higher numerically observed breakthrough CMV rates in D+/R− recipients further support the need for closer monitoring and individualized antiviral management. Overall, these findings identified practice gaps in CMV monitoring and antiviral management at UMMC and support the development of a pharmacist-driven CMV stewardship clinic to improve early intervention, optimize antiviral use, and standardize care for high-risk patients. 

Self-Assessment Question 
Which management strategy best reflects an effective CMV stewardship approach in solid organ transplant recipients?
A. Maintaining uniform antiviral strategies across all recipients to minimize variation in care
B. Escalating antiviral therapy solely in response to persistent DNAemia, irrespective of tolerability or immunologic risk
C. Basing treatment intensity primarily on baseline serostatus, with limited modification after initiation
D. Integrating protocol-driven care with longitudinal reassessment of virologic trends, drug toxicity, and dynamic immunosuppressive burden