Impact of an intern-supported antiviral stewardship program for cytomegalovirus prophylaxis and management in high-risk abdominal solid organ transplant recipients

Abstract

Introduction

Cytomegalovirus (CMV) infection is associated with increased graft loss and mortality after solid organ transplantation (SOT). CMV infection risk is highest among seronegative recipients of seropositive donors (D+/R-). Careful monitoring is imperative to ensure appropriate care.

Objectives

This study investigates the impact of intern-supported pharmacist-driven monitoring on CMV outcomes in D+/R- abdominal SOT recipients.

Methods

A single-center retrospective cohort study was conducted in CMV D+/R- abdominal SOT recipients transplanted between August 1, 2021, and July 31, 2023 to compare recipients undergoing pharmacy intern review versus standard monitoring. A pharmacy student intern reviewed a list of recipients maintained in the electronic health record weekly to ensure proper CMV prophylaxis and management. Following institutional protocols, the intern identified and recommended interventions to the pharmacists for implementation. Primary outcomes included the incidence of CMV infection within 9 months posttransplant and time to CMV eradication after infection. Secondary outcomes included the incidence of antiviral resistance, viral breakthrough, allograft loss, and recipient death.

Results

69 D+/R- SOT recipients were included (36 control, 33 intervention). Baseline demographics were similar. There was a nonsignificant decrease in CMV infection within 9 months posttransplant in the intervention group. However, the mean time to CMV eradication after infection was significantly shorter in the intervention group (63 days vs. 24 days, p = 0.004). No differences in secondary outcomes were observed.

Conclusions

CMV infection rates remained elevated in D+/R- SOT recipients after transplant despite frequent reviews of prophylaxis and laboratory monitoring, which is likely a result of seronegative status and global immunosuppression. However, eradication of CMV infection can be significantly impacted by close monitoring, such as that provided by a pharmacy student intern, to reduce the time of active infection. This dramatic reduction in time to eradication has the potential to reduce the risk for negative allograft and recipient outcomes associated with CMV infection.