Implementing a Systematic Quality Improvement Strategy to Reduce Cytomegalovirus Infection Following Kidney Transplantation.

Abstract

Objectives: Cytomegalovirus is a common oppor-tunistic infection affecting kidney transplant reci-pients that adversely affects allograft function and patient well-being. The risk of infection is highest during the first 6 months posttransplant. Infection surveillance and antiviral drug prophylaxis strategies vary in transplant centers, often stratified based on clinical risk, with strategies ranging from universal antiviral prophylaxis to preemptive viral monitoring. Using a multifaceted approach, we conducted a successful quality improvement project to reduce cytomegalovirus infection rates during the first 6 months after kidney transplantation.

Materials and methods: For the improvement project, we conducted an initial baseline audit and 2 plan-do-study-act cycles between August 2021 and April 2023. After the baseline audit, we devised the following series of interventions: incorporating the Cockcroft Gault creatinine clearance (for valganciclovir dosing) into our electronic renal software for easy availability in clinics, printing dosing cards for clinics, improving awareness of health care professionals, offering valganciclovir prophylaxis to recipients seropositive for cytomegalovirus immunoglobulin G, and actively considering reduction of immunosuppression in suitable kidney transplant recipients after multidis-ciplinary transplant team approval.

Results: With the quality improvement project, overall cytomegalovirus infection rate within 6 months posttransplant decreased from 22.5% to 5.8%, with rates reduced in donor-positive/recipient-negative, donor-positive/recipient-positive, and donor-negative/recipient-positive risk categories. Accuracy of valganciclovir dosing in clinics increased according to the Cockcroft Gault creatinine clearance.

Conclusions: Our work shows how multiple factors need to be addressed to reduce the occurrence of cytomegalovirus infection post kidney transplantation. We reduced the incidence of cytomegalovirus infection within 6 months after kidney transplantation, in all cytomegalovirus risk categories, by adopting a multifaceted quality improvement strategy targeting key factors identified on a baseline audit. Transplant centers should regularly survey cytomegalovirus infection rates and adopt a quality improvement strategy to reduce infection rates given its complexity and detrimental outcomes.