Evaluation of practices for the diagnosis and monitoring of cytomegalovirus infection in kidney transplant recipients in Brazil

Abstract

INTRODUCTION: Cytomegalovirus (CMV) remains a significant challenge in kidney transplantation. Despite prophylactic and preemptive antiviral strategies, clinical practices vary widely. This study assessed CMV diagnostic and monitoring practices in Brazilian kidney transplant centers, focusing on access to diagnostic tools, therapeutic thresholds, and logistical barriers. METHODS: A nationwide electronic survey was conducted between August and October 2024, targeting all kidney transplant programs (TP) registered with the Brazilian Society of Organ Transplantation (ABTO). RESULTS: A total of 35 TP (20.6% response rate) participated, representing 62% of kidney transplants performed in Brazil in 2023. While most centers had CMV management protocols (94.3%), significant variability was observed in the initiation of preemptive therapy (PET). Among high-risk patients (D+/R-), 41.9% followed predefined thresholds. Specific cut-off values were applied in 71.0% of R+ patients and in 45.2% of the low-risk group (D-/R-). Quantitative PCR was the primary diagnostic method (97.1%), with whole blood (60%) and plasma (34.3%) as preferred sample types. A significant proportion of CMV TP (60%) relied on outsourced laboratories for CMV diagnostics, with 82.4% experiencing turnaround times exceeding three days for results. Only 8.6% TP had access to molecular testing for CMV-resistant strains. CONCLUSION: This survey reveals substantial variability in CMV diagnosis and management among Brazilian kidney transplant centers, with limited diagnostic access and delays due to reliance on outsourced laboratories. Expanding diagnostic capacity and standardizing guidelines are essential to improving patient outcomes.