Extended valganciclovir prophylaxis in CMV D+/R− lung transplant recipients

Results from a retrospective, single-center study evaluating the clinical burden of cytomegalovirus (CMV) infection and the impact of extended valganciclovir prophylaxis in CMV donor-seropositive/recipient-seronegative (D+/R−) lung transplant recipients were presented by Manushika Watagodakumbura at the 31st International Congress of The Transplantation Society (TTS), September 20–23, 2026, Sydney, AU.

Key data: Of 313 CMV-seronegative lung transplant recipients, 55% had CMV-seropositive donors. CMV infection developed in 55% (94/172) of D+/R− patients compared with 0.7% (1/141) of D–/R– patients (p < 0.001). Overall, 73% of patients with CMV infection required hospitalization. Among D+/R− patients, extending valganciclovir prophylaxis duration from <7 months to ≥18 months reduced the frequency of CMV infection from 78% to 16% (p < 0.001). Extending valganciclovir prophylaxis from <7 months to ≥18 months also delayed median CMV onset post-transplant (6.9 months vs 24.4 months; p < 0.001) and decreased the duration of hospitalization (44 days vs 29 days; p = 0.03).

Key learning: In this study, longer valganciclovir duration was associated with a lower risk of post-transplant CMV infection, delayed infection onset, and shorter hospitalizations in high-risk D+/R− lung transplant recipients, supporting its extended prophylactic use in this population. Further evaluation is needed to determine the optimal duration of valganciclovir prophylaxis.