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

Autor: Moynan D; Department of Infectious Diseases, Mater Misericordiae University Hospital, Dublin, Ireland., Higgins E; Department of Infectious Diseases, University Hospital Galway, Galway, Ireland., Passerini M; Department of Pathophysiology and Transplantation, University of Milano, Milan, Italy.; Department of Infectious Diseases, ASST FBF SACCO Fatebenefratelli, Milan, Italy., Prokop LJ; Mayo Clinic Libraries, Mayo Clinic, Rochester, Minnesota, USA., Murad MH; Evidence-Based Practice Center, Mayo Clinic, Rochester, Minnesota, USA.; Department of Medicine, Division of Public Health, Infectious Diseases and Occupational Medicine and the William J. von Liebig Center for Transplantation and Clinical Regeneration, Mayo Clinic, Rochester, Minnesota, USA., Razonable RR; Department of Medicine, Division of Public Health, Infectious Diseases and Occupational Medicine and the William J. von Liebig Center for Transplantation and Clinical Regeneration, Mayo Clinic, Rochester, Minnesota, USA.
Jazyk: angličtina
Zdroj: Transplant infectious disease : an official journal of the Transplantation Society [Transpl Infect Dis] 2024 Oct 13, pp. e14393. Date of Electronic Publication: 2024 Oct 13.
DOI: 10.1111/tid.14393
Abstrakt: 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 (I 2 = 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.
(© 2024 The Author(s). Transplant Infectious Disease published by Wiley Periodicals LLC.)
Databáze: MEDLINE
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