Cytomegalovirus (CMV) prevention can be achieved by prophylaxis or preemptive therapy. As no pharmacological CMV prophylaxis is offered by public health system in Brazil we have developed a preemptive CMV monitoring protocol in pancreas transplant(PT) recipients. The aim of this study is to report the outcomes with this preemptive protocol among PT patients.

We analyzed 240 technically successful PT recipients from 2018 to 2022 enrolled in this CMV protocol, being 151 SPK, 74 PAK and 15 PTA. Rabbit thymoglobulin was given at 1-1.5mg/kg/dosage with a cumulative total dose of 5mg/kg for SPK and 7mg/kg for S-PT+SPLK according to total lymphocyte count. Immunosuppresive maintenance included tacrolimus, mycophenolate/sirolimus and steroids for all patients.  Our CMV monitoring protocol included weekly CMV PCR testing from third to 12th week post-transplant. For asymptomatic and pre-transplant IgG+ patients, preemptive therapy with valganciclovir (from 900mg-1800mg/day) was initiated either for a CMV-PCR rise over 20.000IU/ml or a log increase more than 0.5 compared to the last test. For pre-transplant CMV negative or symptomatic patients a PCR threshold of 2500IU/ml triggered CMV treatment.

Pretransplant CMV was positive in 89% of recipients and 87% of pancreas donors. Post-transplant CMV infection or disease occurred in 148(61%) patients, being 129(87%) infections and 21(14.1%) diseases. Readmissions were necessary in 16(6.7%) patients. Infections occurred in average of 44.3 days while CMV disease in average of 39.5 days post-transplant. Patient death was observed in 16(6.7%) patients and only one case due to pulmonar and suspicious of CMV pneumonitis.

Preemptive CMV monitoring and treatment protocol after PT has shown favorable outcomes, preventing use of prophylaxis in 39% of our patients, with a low rate of CMV disease and need of readmission.