Death and Graft Loss in Simultaneous Pancreas-Kidney Recipients by Donor-Recipient Cytomegalovirus Serostatus in the United States.

Cytomegalovirus (CMV) serologic discordance is a known risk factor for adverse outcomes after solid-organ transplantation. This study evaluated outcomes of simultaneous pancreas-kidney (SPK) recipients based on donor and recipient CMV serostatus. Using the Scientific Registry of Transplant Recipients, we identified adult SPK recipients between 2014 and 2024 and categorized them as donor/recipient negative (D-/R-), recipient positive (R+), or donor positive/recipient negative (D+/R-). Patients with missing data, nonstandard immunosuppression, or positive crossmatch were excluded. Among 4,744 recipients (831 D-/R-, 2,671 R+, 1,242 D+/R-), the D+/R- group had the highest 1-year rates of graft rejection (16.6%, p = 0.02) and hospitalization (67.2%, p = 0.005), whereas the D-/R- group had the lowest (11.8% and 60.0%, respectively). In multivariable models, D+/R- recipients had higher risks of death (HR 1.28; 95% CI, 1 .01-1.62; p = 0.045), pancreas graft-loss (HR 1.25; 95% CI, 1.06-1.48; p = 0.009), and death-censored kidney graft-loss (HR 1.31; 95% CI, 1.01-1.69; p = 0.04) compared with R+. Conversely, D-/R- recipients had a lower risk of kidney graft-loss (HR 0.66; 95% CI, 0.46-0.96; p = 0.03). CMV D+/R- serostatus is independently associated with increased mortality and graft-loss after SPK transplantation. Matching CMV-seronegative donors with seronegative recipients may improve outcomes, warranting further study of the feasibility and broader impact of CMV serostatus-based-matching.