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Abstract: SA-PO1078

Navigating the Crossroads: Cytomegalovirus (CMV), Neutropenia, and Kidney Transplant Survival in High-Risk Patients

Session Information

Category: Transplantation

  • 2102 Transplantation: Clinical


  • Muench, Johannes, Charite Universitatsmedizin Berlin, Berlin, Berlin, Germany
  • von Hoerschelmann, Ellen, Charite Universitatsmedizin Berlin, Berlin, Berlin, Germany
  • Budde, Klemens, Charite Universitatsmedizin Berlin, Berlin, Berlin, Germany
  • Halleck, Fabian, Charite Universitatsmedizin Berlin, Berlin, Berlin, Germany

Cytomegalovirus (CMV) infections constitute a significant condition in kidney transplant (KT) recipients with a major impact on morbidity, mortality and graft survival, with CMV negative recipients (R-) transplanted from a CMV positive donor (D+) at highest risk. The prevention of CMV disease in KT recipients mainly relies on antiviral prophylaxis and preemptive therapy with virostatics, e.g., valganciclovir (VGCV). Although these strategies proved to be efficient, their use is limited due to substance related toxicities. This study aims to evaluate the effects of VGCV administration on the development of neutropenia and graft survival in CMV high risk KT.


A retrospective data analysis was used to analyze KT recipients with CMV high risk constellation, transplanted at Charité Berlin (Germany) between 2003-2019. The incidence of neutropenia (<1/nl), severe neutropenia (<0.5/nl) and KT survival within the first 2 years after KT was assessed for recipients with and without a VGCV prophylaxis during day 0-200.


556 patients with CMV high risk constellation received a KT, including 437 (78.6%) and 119 (22.4%) with and without prophylactic VGCV administration, respectively. The likelihood of developing (severe) neutropenia was elevated in KT recipients with VGCV administration (log-rank 0.0289, Fig.A). The time to onset of neutropenia was 145±96 days for recipients with VGCV prophylaxis and 122±84 days for those without VGCV (p=0.062). The development of neutropenia was associated with an increased risk of graft failure within the first 2 years (p<0.01, Fig.B). However, VGCV administration was not linked to reduced graft survival (p=0.482).


Our results show that VGCV prophylaxis in CMV high-risk KT recipients is linked to an increased likelihood of developing neutropenia. However, the timing of the onset of neutropenia is not significantly altered by VGCV. Given the potential negative impact of neutropenia on KT outcomes, it is crucial to closely monitor neutropenic KT recipients. Further research may elucidate if targeting neutropenia could improve KT outcomes.


  • Commercial Support – MSD