Korean J Transplant.  2023 Nov;37(Suppl 1):S229. 10.4285/ATW2023.F-8170.

Preemptive versus prophylactic therapy using valganciclovir or ganciclovir in renal transplant recipients for the prevention of cytomegalovirus infection: a systematic review and meta-analysis

• Te MW
• Boado C
• Vergara-Rejante L
• Suarez EE

• KMID: 2551849
• DOI: http://doi.org/10.4285/ATW2023.F-8170

Abstract

Background
Kidney transplant recipients are at risk for developing cytomegalovirus (CMV) disease and subsequently, allograft rejection and graft loss. The current practice of prophylaxis with antiviral therapy in the early posttransplant period for high risk patients is costly. Preemptive therapy involves a protocol of routine testing for CMV viral load, and treatment is initiated for positive patients. It is unknown if preemptive therapy is an effective strategy to prevent CMV disease. This study aims to assess the efficacy of preemptive versus prophylactic therapy with valganciclovir or ganciclovir in preventing CMV disease in kidney transplant recipients.
Methods
A comprehensive search of PubMed/Medline, Cochrane, and Google scholar was performed to identify clinical trials on the efficacy of preemptive versus prophylactic valganciclovir or ganciclovir in preventing CMV disease. The primary outcome is development of CMV infection. Secondary outcomes include acute allograft rejection, allograft loss, and mortality.
Results
The study included five randomized control trials having a total of 855 kidney transplant recipients. The primary outcome showed that CMV infection was 2.27 times more likely to develop in patients who were given preemptive therapy than those given prophylactic therapy (RR, 2.27; 95% confidence interval [CI], 1.86–2.76; P<0.00001). Secondary outcomes showed that the risk of acute allograft rejection was 1.13 times more likely for preemptive therapy (RR, 1.13; 95% CI, 0.87–1.48; P=0.35). The risk for allograft loss was 1.44 times more likely for preemptive therapy (RR, 1.44; 95% CI, 0.85–2.45; P=0.18), and the risk for mortality was 1.4 times more likely for preemptive therapy (RR, 1.4; 95% CI, 0.54–3.63; P=0.49).
Conclusions
Among kidney transplant recipients, preemptive therapy with valganciclovir or ganciclovir is less effective than prophylactic therapy in the prevention of CMV disease. The incidences of acute allograft rejection, allograft loss, and mortality are more frequent in the preemptive group, but these differences are not significant.