Background CMV infection is among the most common complication after liver transplantation which may result in graft loss, survival and increased cost. There are two major strategies for CMV disease prevention after transplantation: preemptive therapy and universal prophylaxis. We present our cohort of recipients of Living Donor Liver Transplant (LDLT) with non-detectable CMV DNA pre-transplant, with moderate risk of CMV viremia (D+/R+, d-/R+), who were preemptively treated.

Aim To determine whether preemptive strategy may be feasible approach in patients with moderate risk for CMV viremia in LDLT and its appropriateness for Acute Cellular Rejection(ACR), length of hospital stay and risk of developing other infection and all-cause mortality.

Method In this retrospective cohort, 225 adults with moderate risk for CMV viremia who underwent LDLT at Shifa International Hospital from 29/4/2011 to 26/4/2016 were included. All recipients were checked for CMV viremia at day 7, patients with significant viremia (DNA >137 IU/ml) were treated for CMV preemptively. Non-viremic patients on day 7 were only re-checked if had deranged LFT on follow up.

Results Out of 225 patients, 83 (36.8%) patients had detectable CMV DNA at day 7. Patients with higher pre-transplant MELD >18 had more chances of developing CMV viremia n=42 (50.6) than those with MELD <18 n=41 (49.4) (p=0.018).There was no significant difference in patients with/without CMV viremia for ACR (p=0.48), length of hospital stay, incidence of sepsis and all cause mortality.

Conclusions Pre-emptive CMV strategy may be an acceptable approach in patients with moderate risk of CMV viremia in resource constraint setting; however, this needs prospective randomised trials for validation.