Preemptive versus prophylactic protocol to prevent cytomegalovirus infection after renal transplantation: a meta-analysis and systematic review of randomized controlled trials

Abstract

Objective: This review was conducted to assess the efficacy of preemptive versus prophylactic protocols for the prevention and treatment of cytomegalovirus (CMV) infection and disease after renal transplantation.

Methods: PubMed, EMBASE, the Cochrane Library, SCI, the China Journal Full-text Database, the Chinese Biomedical Database, the Chinese Scientific Journals Full-text Database, and the CMA Digital Periodicals were searched to collect randomized controlled trials (RCTs) of preemptive versus prophylactic protocols for the prevention and treatment of CMV infections after renal transplantation (up to April 2010). Two reviewers independently extracted data using a designed extraction form. The quality of the included trials was evaluated according to the Cochrane Handbook. RevMan 5.0 software was used for data analysis.

Results: Seven RCTs, involving 560 patients, were included. The results of the meta-analysis were as follows: the prophylactic protocol was significantly more effective than the preemptive protocol in reducing CMV infections and the recurrence rates of CMV infection; both the preemptive protocol and the prophylactic protocol reduced the risk of CMV disease, with no significant differences; no significant differences were observed in the risks of mortality, acute rejection, graft loss, other infections, or neutropenia between preemptive therapy and prophylaxis.

Conclusion: Preemptive protocols are as effective as prophylaxis in reducing the risk of CMV disease in renal transplant recipients, whereas the prophylactic protocols could more effectively reduce the CMV recurrence rates. However, the trial data were very sparse, so further observations of the long-term effects of the protocols are needed.