Cytomegalovirus prophylaxis with antiviral agents in solid organ transplantation: a meta-analysis.
نویسندگان
چکیده
BACKGROUND The aim of this meta-analysis was to assess the efficacy of antiviral agents to prevent, in solid organ transplant recipients, cytomegalovirus infection and symptomatic disease and to decrease the incidence of acute rejection, graft loss, and death. METHODS Of the studies identified, 13 met the following inclusion criteria: prospective randomized study, in adults or pediatric recipients of a solid organ transplant, where one group in the study received a prophylactic treatment with acyclovir and/or ganciclovir begun before the cytomegalovirus infection and a control group was not treated or receive placebo. RESULTS Prophylactic treatment was found to be associated with a significant decrease of cytomegalovirus disease compared with placebo or no treatment, using the logarithm of relative risk method (relative risk=0.50; 95% confidence interval, 0.40-0.62; P-value for chi-square association <0.001). Prophylactic treatment decreased also the rate of cytomegalovirus infection (relative risk=0.74; 95% confidence interval, 0.62-0.88; P<0.001). Our analysis failed to show a significant decrease of graft loss, acute rejection, and death in the prophylactic treatment group. Subgroup analysis based on the type of antiviral agent (acyclovir or ganciclovir) and on the type of organ (kidney or liver) gave comparable results. CONCLUSION The use of antiviral agents for the prevention of cytomegalovirus disease and cytomegalovirus infection in solid organ transplantation is supported by this meta-analysis.
منابع مشابه
Antiviral agents for preventing cytomegalovirus infection in pediatric renal transplant recipients: A systematic review
Background and Objective: Cytomegalovirus (CMV) infections are associated with severe morbidity and mortality in patients, especially pediatric renal transplantation patients. The use of immunosuppressive agents places these patients at the risk of viral infections. As cytomegalovirus infection influences the graft outcome, adopting useful strategies for limiting this virus after transplantatio...
متن کاملThe CARI guidelines. CMV disease and kidney transplant: prophylaxis for cytomegalovirus infection in patients following renal transplantation.
a. Prophylactic treatment for Cytomegalovirus (CMV) is recommended in solid organ transplantation as it is associated with a significant decrease in CMV disease and infection compared with placebo or no treatment (approximately a 50% and 40% decrease in relative risk, respectively) (Level I evidence). b. The use of the antiviral agents oral valganciclovir, oral valaciclovir, and intravenous gan...
متن کاملClinical aspects of cytomegalovirus antiviral resistance in solid organ transplant recipients.
Despite advances in the prophylaxis and acute treatment of cytomegalovirus (CMV), it remains an important pathogen affecting the short- and long-term clinical outcome of solid organ transplant. The emergence of CMV resistance in a patient reduces the clinical efficacy of antiviral therapy, complicates therapeutic and clinical management decisions, and in some cases results in loss of the allogr...
متن کاملAntiviral medications for preventing cytomegalovirus disease in solid organ transplant recipients.
BACKGROUND The risk of cytomegalovirus (CMV) infection in solid organ transplant recipients has resulted in the frequent use of prophylaxis with the aim of preventing the clinical syndrome associated with CMV infection. OBJECTIVES To determine the benefits and harms of antiviral medications to prevent CMV disease and all-cause mortality in solid organ transplant recipients. SEARCH STRATEGY ...
متن کاملCytomegalovirus Infections in Solid Organ Transplantation: A Review
Cytomegalovirus (CMV) continues to have a tremendous impact in solid organ transplantation despite remarkable advances in its diagnosis, prevention and treatment. It can affect allograft function and increase patient morbidity and mortality through a number of direct and indirect effects. Patients may develop asymptomatic viremia, CMV syndrome or tissue-invasive disease. Late-onset CMV disease ...
متن کاملذخیره در منابع من
با ذخیره ی این منبع در منابع من، دسترسی به آن را برای استفاده های بعدی آسان تر کنید
برای دانلود متن کامل این مقاله و بیش از 32 میلیون مقاله دیگر ابتدا ثبت نام کنید
ثبت ناماگر عضو سایت هستید لطفا وارد حساب کاربری خود شوید
ورودعنوان ژورنال:
- Transplantation
دوره 65 5 شماره
صفحات -
تاریخ انتشار 1998