Real World Utilization of Protocolized T‐Cell Immunity Panel Screening in Cytomegalovirus Seropositive Kidney Transplant Recipients

ABSTRACT Background Recently updated guidelines suggest monthly cytomegalovirus (CMV) cell‐mediated immunity (CMI) testing in seropositive (R+) kidney transplant recipients to stratify posttransplant CMV risk and guide prophylaxis. UW Health has protocolized T‐cell immunity panel (TCIP) testing since 2023. The purpose was to assess real‐world implementation of TCIP testing and the feasibility of this approach. Methods This retrospective cohort study included adult R+ renal transplant (RTX) recipients transplanted March 1, 2023, to April 9, 2025, received lymphocyte depleting induction and completed TCIP testing at 3 months posttransplant. Results Here, 234 patients were eligible for protocolized TCIP testing during the study period, with 160 patients obtaining a TCIP (68.4%). Mean time to TCIP draw was 94 ± 15.6 days post‐RTX. Of those who obtained TCIP, 75 had positive, 57 negative, and 28 with indeterminate results. Significantly more patients with indeterminate TCIP received alemtuzumab induction (8.0% vs. 8.8%vs. 89.3%, p < 0.0001). Positive TCIP facilitated significantly shorter prophylaxis duration (153.8 vs. 172.2 vs. 180.1 days, p = 0.003). WBC were significantly lower among patients with an indeterminate TCIP (6.3 vs. 6.1 vs. 4.4 × 10 3 cells/mm 3 , p = 0.0006). Patients with indeterminate TCIP were more likely to have ALC ≤ 400 cells/µL (32.0% vs. 33.3% vs. 89.3%, p < 0.0001). Incidence of post‐prophylaxis CMV infection was comparable. Conclusion In this study, implementing protocolized TCIP testing at 3 months posttransplant in R+ kidney transplant recipients was feasible, with the main limitation being lab related draw‐time considerations. Based on our center specific experience, stratification based on patient‐specific factors should be considered before widespread implementation to optimize evaluable results given cost burden associated with testing.