Efficacy and safety of conventional antiviral agents in preventive strategies for cytomegalovirus infection after kidney transplantation: a systematic review and network meta‐analysis. (28th October 2021)

• Record Type: Journal Article
• Authors: Ruenroengbun, Narisa; Numthavaj, Pawin; Sapankaew, Tunlanut; Chaiyakittisopon, Kamolpat; Ingsathit, Atiporn; Mckay, Gareth J.; Attia, John; Thakkinstian, Ammarin
• Is Part Of: Transplant international. Volume 34:Number 12(2021)
• Page Start: 2720
• Page End: 2734
• Publication Date: 2021-10-28
• Subjects: cytomegalovirus -- kidney transplant -- universal‐prophylaxis; Transplantation of organs, tissues, etc -- Periodicals; 617.95405
• DOI: 10.1111/tri.14122
• Languages: English
• ISSNs: 0934-0874

Abstract

Summary: Cytomegalovirus (CMV) infection is common in kidney transplantation (KT). Antiviral‐agents are used as universal prophylaxis. Our purpose aimed to compare and rank efficacy and safety. MEDLINE, Embase, SCOPUS, and CENTRAL were used from inception to September 2020 regardless language restriction. We included randomized clinical trials (RCTs) comparing the CMV infection/disease prophylaxis among antiviral‐agents in adult KT recipients. Of 24 eligible RCTs, prophylactic valganciclovir (VGC) could significantly lower the overall CMV infection and disease risks than placebo with pooled risk differences (RDs) [95% confidence interval (CI)] of −0.36 (−0.54, −0.18) and −0.28 (−0.48, −0.08), respectively. Valacyclovir (VAC) and ganciclovir (GC) significantly decreased risks with the corresponding RDs of −0.25 (−0.32, −0.19) and −0.30 (−0.37, −0.22) for CMV infection and −0.26 (−0.40, −0.12) and −0.22 (−0.31, −0.12) for CMV disease. For subgroup analysis by seropositive‐donor and seronegative‐recipient (D+/R−), VGC and GC significantly lowered the risk of CMV infection/disease with RDs of −0.42 (−0.84, −0.01) and −0.35 (−0.60, −0.12). For pre‐emptive strategies, GC lowered the incidence of CMV disease significantly with pooled RDs of −0.33 (−0.47, −0.19). VGC may be the best in prophylaxis of CMV infection/disease follow by GC. VAC might be an alternative where VGC and GC are not available. Abstract : Valganciclovir is the best efficacy and safety in long‐term CMV prophylaxis in kidney transplant recipients regarding in high‐risk group, while ganciclovir is the second rank. For valacyclovir is an alternative in a valgaciclovir‐limited area when regardless of donor/recipients CMV serologies.