Safety and efficacy of a reduced frequency post-transplant monitoring strategy for EBV, CMV, and BKV.
BACKGROUND: There is a lack of consensus on optimal viral monitoring protocol for kidney transplant recipients. In response to the increased demand on laboratory testing during the COVID-19 pandemic, the Transplant Manitoba Adult Kidney Program (TMAKP) adopted reduced frequency monitoring protocols for cytomegalovirus (CMV), Epstein Barr virus (EBV), and BK polyomavirus (BKV). METHODS: This single-center retrospective observational cohort study evaluated 341 adult kidney transplant recipients transplanted between January 2015 to March 2021, with the change in protocol effective on March 19th 2020. Recipients transplanted prior to March 19, 2019 comprised the pre-protocol cohort, while those transplanted after March 19, 2020 were contained in the post-protocol cohort. For each viremia, an incident cohort consisting of recipients transplanted post-protocol change who developed viremia were matched to historical controls from the pre-protocol era. The prevalent cohort consisted of recipients transplanted in the pre-protocol period with established viremia prior to the protocol change. RESULTS: There were no significant differences in maximum viral load between incident cases and controls in titers of EBV, CMV, or BKV. Among recipients with established viremia pre-protocol change, and who had at least one viral load checked post-protocol change, median viral load was significantly lower post-protocol in the CMV (860 vs 0 copies/mL, p<0.0001) and BKV (26500 vs 500 copies/mL, p<0.0001) prevalent cohorts, but not the EBV cohort. CONCLUSION: Our findings suggest that reduced frequency monitoring may be safe and cost-effective. Future studies with longer follow-up are needed to better evaluate long term outcomes.