It is recommended to start cytomegalovirus (CMV) prophylaxis within ten days of solid organ transplant, if indicated. Our center underwent a cost-savings initiative to delay CMV prophylaxis initiation from postoperative day zero to postoperative day seven or upon discharge, hypothesizing this would not affect clinical outcomes but could impact costs. The purpose of this retrospective study was to determine the effects of early versus delayed (<72 hours versus > 72 hours after transplant) CMV prophylaxis in kidney and kidney/pancreas transplant recipients transplanted between June 2014-January 2017. The primary endpoint was incidence of CMV infection within one year. Secondary endpoints included CMV disease, CMV testing, and valganciclovir cost during index hospitalization. A total of 173 patients (114 early, 59 delayed) were included. CMV infection occurred in 61% versus 54% in the early versus delayed group (p=0.5).Excluding low-level DNAemia (QNAT <200 IU/mL), infection occurred in 30% versus 22% in the early versus late group (p=0.4). The median days to starting prophylaxis was 0 and 6 in the early and delayed group (p<0.05), which led to a median cost savings of $497.00 per patient during index hospitalization (p<0.05). Delaying prophylaxis initiation did not impact CMV outcomes in this cohort and decreased costs.
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