CMV remains a well-recognized cause of morbidity among HTx recipients and is associated with both direct and indirect effects following transplantation. 1-5 CMV discordant (D+/R−) recipients remain at HR for CMV infection and disease following transplant, followed by CMV (R+) and (D−R−) recipients, respectively. While current guidelines outline describe a number of potential CMV management strategies following SOT including antiviral prophylaxis, preemptive therapy, and hybrid approaches, universal antiviral prophylaxis is recommended for HR CMV discordant (D+/R−) HTx recipients. 2 VGC, an oral prodrug of ganciclovir, is widely used following HTx and has been shown to decrease CMV infection and disease among adult HTx recipients. 6-9 Yet few studies to date have explored the burden