Prophylactic vs preemptive strategy for the prevention of CMV disease in solid organ transplant recipients: systematic review and meta-analysis of randomized controlled trials.

IF 5.4 2区医学 Q1 INFECTIOUS DISEASES

Infection Pub Date : 2024-11-22 DOI:10.1007/s15010-024-02441-4

Niv Reiss-Gindi, Tomer Hoffman, Tanya Ruderman, Alaa Atamna, Ili Margalit, Dafna Yahav

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引用次数: 0

Abstract

Purpose: Cytomegalovirus (CMV) is associated with significant morbidity and mortality among solid organ transplant (SOT) recipients. Strategies for CMV prevention include universal prophylaxis or preemptive approach. We aimed to evaluate the optimal approach.

Methods: We performed a systematic review and meta-analysis of randomized controlled trials comparing prophylaxis versus preemptive therapy for CMV in SOT. The primary outcome was CMV disease. Subgroup analysis of outcomes in D+ R- patients was performed.

Results: Nine trials have met inclusion criteria, five of them included kidney transplant recipients, all compared val/ganciclovir universal prophylaxis versus preemptive approach. Universal prophylaxis resulted in lower probability of CMV infection (relative risk [RR] 0.44, 95% confidence interval [CI] 0.33-0.58), yet the impact on CMV disease was insignificant (RR 0.54, 95% CI 0.24-1.23), in neither SOT recipients in general nor among D+R- subgroup (RR 0.93, 95% CI 0.37-2.32). Late-onset CMV disease rates were lower with preemptive approach. Sensitivity analysis according to allocation concealment and blinding showed similar results for CMV disease. No significant differences were demonstrated for the outcomes of mortality, bacterial or fungal infection or graft related outcomes. Acute kidney injury was significantly more common with prophylaxis (RR 1.79, 95% CI 1.12-2.89).

Conclusion: Preemptive approach is a reasonable approach for CMV prevention in SOT recipients, if feasible. Strategies for combining the preemptive with prophylaxis strategies, as well as immune monitoring, should be investigated.

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在实体器官移植受者中预防 CMV 疾病的预防性策略与先发制人的策略：随机对照试验的系统回顾与荟萃分析。

目的：巨细胞病毒（CMV）与实体器官移植（SOT）受者的发病率和死亡率密切相关。预防 CMV 的策略包括普遍预防或先期预防。我们旨在评估最佳方法：我们对随机对照试验进行了系统回顾和荟萃分析，比较了在 SOT 中 CMV 的预防性治疗和抢先治疗。主要结果是 CMV 疾病。对 D+ R- 患者的结果进行了分组分析：九项试验符合纳入标准，其中五项包括肾移植受者，所有试验都比较了缬氨酸/更昔洛韦的普遍预防与抢先治疗。普遍预防可降低CMV感染概率（相对风险[RR] 0.44，95% 置信区间[CI] 0.33-0.58），但对CMV疾病的影响并不显著（RR 0.54，95% CI 0.24-1.23），无论是在一般SOT受者中还是在D+R-亚组中（RR 0.93，95% CI 0.37-2.32）。采用预防性方法后，晚期CMV发病率较低。根据分配隐藏和盲法进行的敏感性分析显示，CMV 疾病的结果相似。在死亡率、细菌或真菌感染或移植物相关结果方面没有明显差异。急性肾损伤在预防性治疗中更为常见（RR 1.79，95% CI 1.12-2.89）：结论：在可行的情况下，预防性治疗是在 SOT 受者中预防 CMV 的合理方法。结论：在可行的情况下，预防性治疗是 SOT 受体中预防 CMV 的合理方法。应研究将预防性治疗与预防性治疗相结合的策略，并进行免疫监测。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Infection 医学-传染病学

CiteScore

12.50

自引率

1.30%

发文量

224

审稿时长

6-12 weeks

期刊介绍： Infection is a journal dedicated to serving as a global forum for the presentation and discussion of clinically relevant information on infectious diseases. Its primary goal is to engage readers and contributors from various regions around the world in the exchange of knowledge about the etiology, pathogenesis, diagnosis, and treatment of infectious diseases, both in outpatient and inpatient settings. The journal covers a wide range of topics, including: Etiology: The study of the causes of infectious diseases. Pathogenesis: The process by which an infectious agent causes disease. Diagnosis: The methods and techniques used to identify infectious diseases. Treatment: The medical interventions and strategies employed to treat infectious diseases. Public Health: Issues of local, regional, or international significance related to infectious diseases, including prevention, control, and management strategies. Hospital Epidemiology: The study of the spread of infectious diseases within healthcare settings and the measures to prevent nosocomial infections. In addition to these, Infection also includes a specialized "Images" section, which focuses on high-quality visual content, such as images, photographs, and microscopic slides, accompanied by brief abstracts. This section is designed to highlight the clinical and diagnostic value of visual aids in the field of infectious diseases, as many conditions present with characteristic clinical signs that can be diagnosed through inspection, and imaging and microscopy are crucial for accurate diagnosis. The journal's comprehensive approach ensures that it remains a valuable resource for healthcare professionals and researchers in the field of infectious diseases.