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Meta-Analysis
. 2024 Dec;26(6):e14393.
doi: 10.1111/tid.14393. Epub 2024 Oct 13.

Secondary anti-viral prophylaxis in solid organ transplant recipients for the prevention of cytomegalovirus relapse: A systematic review and meta-analysis

David Moynan  1 , Eibhlin Higgins  2 , Matteo Passerini  3   4 , Larry J Prokop  5 , Mohammad Hassan Murad  6   7 , Raymund R Razonable  7
Affiliations
Meta-Analysis

Secondary anti-viral prophylaxis in solid organ transplant recipients for the prevention of cytomegalovirus relapse: A systematic review and meta-analysis

David Moynan et al. Transpl Infect Dis. 2024 Dec.

Abstract

Background: Cytomegalovirus (CMV) is a significant cause of morbidity and mortality in solid organ transplant recipients (SOTRs). Secondary prophylaxis (SP) is not routinely recommended by guidelines on the management of CMV in SOTR but may be considered in certain higher-risk situations.

Methods: A comprehensive search of English language publications up to September 2023 was performed. The primary outcome was CMV relapse, defined as the recurrence of DNAemia or disease. Secondary outcomes included graft loss, mortality, and hematological toxicity. Meta-analysis used the random-effects model. The study protocol is registered in PROSPERO (no. CRD42022357028).

Results: Six retrospective comparative studies were included. A total of 520/727 (72%) of SOTR received SP with valganciclovir. The meta-analysis did not demonstrate a significant difference in CMV relapse (odds ratio [OR] 1.15, 95% confidence interval [CI] 0.79-2.63). Heterogeneity between the studies was low (I2 = 0%, p = 0.57). SP was significantly associated with a reduction in mortality (OR 0.2, 95% CI 0.07-0.54) but not graft loss (OR 0.67, 0.17-2.63). There was no significant difference in CMV relapse among kidney-specific SOTR (OR 1.38, 95% CI 0.65-2.96).

Conclusion: Evidence from six nonrandomized studies is limited and cannot support a recommendation for or against routine SP in SOTR treated for CMV infection. Awaiting prospective-controlled trials, the decision about SP should depend on individualized risk-profile assessments by experienced clinicians.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

FIGURE 1
FIGURE 1
PRISMA flow chart demonstrating the study selection process.
FIGURE 2
FIGURE 2
Meta‐analysis of secondary anti‐viral prophylaxis on cytomegalovirus (CMV) relapse, graft loss, death, and hematological toxicity (CI, confidence interval; OR, odds ratio).
FIGURE 3
FIGURE 3
Subgroup analysis examining secondary anti‐viral prophylaxis on cytomegalovirus (CMV) relapse, graft loss, death, and hematological toxicity in kidney‐specific SOTR (CI, confidence interval; OR, odds ratio).
See this image and copyright information in PMC

References

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