1749. A Nationwide Survey of Cytomegalovirus Prevention Strategies in Kidney Transplant Recipients in a Resource-Limited Setting

BACKGROUND: Cytomegalovirus (CMV) causes morbidity in kidney transplant (KT) recipients. Strategies to prevent this infection in resource-limited settings have been unreliably implemented and under-explored. We investigated CMV prevention strategies utilized among transplant centers in Thailand. METHODS: A questionnaire on CMV prevention strategies for KT recipients was developed using a web-based electronic survey website (www.surveymonkey.com). The survey was delivered to 31 transplant centers in Thailand. One infectious disease physician (ID) and one nephrologist (NP) from each center were included. RESULTS: There were 43 respondents from 26 (84%) transplant centers including 26 (60%) IDs and 17 (40%) NPs. The majority worked in a public hospital setting (63%) and had encountered KT recipients for at least 2 years (74%). Forty-one (98%) physicians agreed on the necessity of CMV prevention. Of these, 34 (81%) physicians implemented prevention strategies for their patients. Interventions included preemptive approaches (47%), prophylaxis (44%), hybrid approaches (3%); surveillance after prophylaxis (3%), and CMV-specific immunity-guided approaches (3%). For CMV-seropositive KT recipients, use of preemption (84%) exceeded prophylaxis (12%). However, 81% of the former preferred targeted prophylaxis in patients receiving anti-thymocyte globulin therapy. Sixty-five and 93% of physicians started preemptive therapy when plasma CMV DNA loads reached 2,000 and 3,000 copies/mL (1,820 and 2,730 IU/mL), respectively. A significantly greater percentage of NPs initiated preemptive therapy at a plasma CMV level of 1,820 IU/mL compared with IDs (88% vs. 50%, [P = 0.02]). The most common barrier to prevention strategy implementation was financial inaccessibility of oral valganciclovir (67%) and quantitative CMV DNA testing (12%). The majority (81%) felt that a guideline would allow physicians to implement CMV prevention strategies for their patients. CONCLUSION: Most physicians agreed on a need for preemptive approaches, although prophylaxis was targeted in those receiving intense immunosuppression. Guidelines and financial accessibility could improve CMV prevention strategy implementation in Thai KT recipients. DISCLOSURES: All authors: No reported disclosures.