Logical versus absolute lymphocyte count–guided preemptive therapy for cytomegalovirus prevention in kidney transplant recipients: a randomized controlled trial
Issued Date
2026-03-01
Resource Type
ISSN
12019712
eISSN
18783511
Scopus ID
2-s2.0-105027695259
Pubmed ID
41422944
Journal Title
International Journal of Infectious Diseases
Volume
164
Rights Holder(s)
SCOPUS
Bibliographic Citation
International Journal of Infectious Diseases Vol.164 (2026)
Suggested Citation
Lorcharassriwong P., Boongird S., Kantachuvesiri S., Yingchoncharoen T., Sutharattanapong N., Bruminhent J. Logical versus absolute lymphocyte count–guided preemptive therapy for cytomegalovirus prevention in kidney transplant recipients: a randomized controlled trial. International Journal of Infectious Diseases Vol.164 (2026). doi:10.1016/j.ijid.2025.108311 Retrieved from: https://repository.li.mahidol.ac.th/handle/123456789/114496
Title
Logical versus absolute lymphocyte count–guided preemptive therapy for cytomegalovirus prevention in kidney transplant recipients: a randomized controlled trial
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Corresponding Author(s)
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Abstract
Objectives A preemptive approach using plasma cytomegalovirus (CMV) DNA load monitoring is recommended for CMV-seropositive solid organ transplant recipients. However, limited access to CMV quantitative nucleic acid amplification testing poses challenges in resource-constrained settings. We hypothesized that absolute lymphocyte count (ALC)-guided monitoring could provide an effective alternative strategy. Methods We conducted an open-label, randomized controlled trial at a single transplant center in Thailand (February-November 2023). Adult CMV-seropositive kidney transplant (KT) recipients who did not receive anti-thymocyte globulin induction were randomized in a 1:1 ratio to either the logical (LOG) group, defined as routine plasma CMV quantitative nucleic acid amplification testing performed every 4 weeks for 12 weeks, or the ALC group, which underwent testing only when the ALC was <1000 cells/mm³. Participants were followed for 6 months after transplantation to compare CMV infection rates and testing costs. Results A total of 98 KT recipients were enrolled (49 per group; mean ± SD age, 46 ± 11 years; 66.3% male). Baseline demographic characteristics were comparable between groups. Overall, 25 participants (25.5%) developed CMV infection within 6 months after KT. CMV infection occurred in 13 participants (26.5%) in the LOG group and 12 participants (24.5%) in the ALC group (P = 0.817). No significant differences were observed between groups in the rates of CMV DNAemia, CMV disease, anti-CMV therapy, or mortality (all P >0.05). The total cost of plasma CMV DNA load testing was significantly lower in the ALC group than in the LOG group ($2320 vs $10,014; P = 0.002). Conclusions ALC-guided monitoring could demonstrate effectiveness comparable to that of routine CMV DNA surveillance for CMV infection prevention in KT recipients. Given its simplicity and availability, ALC may serve as a feasible and cost-efficient adjunct for guiding preemptive therapy in low- to moderate-risk solid organ transplant recipients.