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Antiviral medications for preventing cytomegalovirus disease in solid organ transplant recipients

  1. Elisabeth M Hodson1,2,*,
  2. Maleeka Ladhani1,
  3. Angela C Webster2,3,4,
  4. Giovanni FM Strippoli2,4,5,6,7,
  5. Jonathan C Craig2,4

Editorial Group: Cochrane Renal Group

Published Online: 28 FEB 2013

Assessed as up-to-date: 11 JUL 2011

DOI: 10.1002/14651858.CD003774.pub4


How to Cite

Hodson EM, Ladhani M, Webster AC, Strippoli GFM, Craig JC. Antiviral medications for preventing cytomegalovirus disease in solid organ transplant recipients. Cochrane Database of Systematic Reviews 2013, Issue 2. Art. No.: CD003774. DOI: 10.1002/14651858.CD003774.pub4.

Author Information

  1. 1

    The Children's Hospital at Westmead, Centre for Kidney Research, Westmead, NSW, Australia

  2. 2

    The University of Sydney, Sydney School of Public Health, Sydney, NSW, Australia

  3. 3

    The University of Sydney at Westmead, Centre for Transplant and Renal Research, Westmead Millennium Institute, Westmead, NSW, Australia

  4. 4

    The Children's Hospital at Westmead, Cochrane Renal Group, Centre for Kidney Research, Westmead, NSW, Australia

  5. 5

    University of Bari, Department of Emergency and Organ Transplantation, Bari, Italy

  6. 6

    Mario Negri Sud Consortium, Department of Clinical Pharmacology and Epidemiology, Santa Maria Imbaro, Italy

  7. 7

    Diaverum, Medical-Scientific Office, Lund, Sweden

*Elisabeth M Hodson, elisabeth.hodson@health.nsw.gov.au.

Publication History

  1. Publication Status: New search for studies and content updated (conclusions changed)
  2. Published Online: 28 FEB 2013

SEARCH

[Figure 1]
Figure 1. Study flow diagram.
[Figure 2]
Figure 2. Funnel plot of 19 trials comparing antiviral medications with placebo or no treatment
[Figure 3]
Figure 3. CMV disease: cumulative meta-analysis showing change over time
[Figure 4]
Figure 4. All-cause mortality cumulative meta-analysis showing change over time
[Figure 5]
Figure 5. Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies
[Figure 6]
Figure 6. Risk of bias summary: review authors' judgements about each risk of bias item for each included study
[Analysis 1.1]
Analysis 1.1. Comparison 1 Antiviral prophylaxis versus placebo/no treatment, Outcome 1 CMV disease and CMV infection in all treated patients.
[Analysis 1.2]
Analysis 1.2. Comparison 1 Antiviral prophylaxis versus placebo/no treatment, Outcome 2 All symptomatic CMV disease stratified by antibody status.
[Analysis 1.3]
Analysis 1.3. Comparison 1 Antiviral prophylaxis versus placebo/no treatment, Outcome 3 CMV disease in all patients by antiviral medication.
[Analysis 1.4]
Analysis 1.4. Comparison 1 Antiviral prophylaxis versus placebo/no treatment, Outcome 4 CMV disease for different organ transplants.
[Analysis 1.5]
Analysis 1.5. Comparison 1 Antiviral prophylaxis versus placebo/no treatment, Outcome 5 CMV disease and ganciclovir duration.
[Analysis 1.6]
Analysis 1.6. Comparison 1 Antiviral prophylaxis versus placebo/no treatment, Outcome 6 ATG therapy and antiviral efficacy.
[Analysis 1.7]
Analysis 1.7. Comparison 1 Antiviral prophylaxis versus placebo/no treatment, Outcome 7 Immunosuppression without ATG induction and antiviral efficacy.
[Analysis 1.8]
Analysis 1.8. Comparison 1 Antiviral prophylaxis versus placebo/no treatment, Outcome 8 Mortality due to CMV disease or other causes.
[Analysis 1.9]
Analysis 1.9. Comparison 1 Antiviral prophylaxis versus placebo/no treatment, Outcome 9 All-cause mortality according to antiviral medication.
[Analysis 1.10]
Analysis 1.10. Comparison 1 Antiviral prophylaxis versus placebo/no treatment, Outcome 10 All-cause mortality according to CMV status.
[Analysis 1.11]
Analysis 1.11. Comparison 1 Antiviral prophylaxis versus placebo/no treatment, Outcome 11 All-cause mortality for different organ transplants.
[Analysis 1.12]
Analysis 1.12. Comparison 1 Antiviral prophylaxis versus placebo/no treatment, Outcome 12 All-cause mortality and ganciclovir duration.
[Analysis 1.13]
Analysis 1.13. Comparison 1 Antiviral prophylaxis versus placebo/no treatment, Outcome 13 Additional outcomes - all medications.
[Analysis 1.14]
Analysis 1.14. Comparison 1 Antiviral prophylaxis versus placebo/no treatment, Outcome 14 Acute rejection according to method of diagnosis.
[Analysis 1.15]
Analysis 1.15. Comparison 1 Antiviral prophylaxis versus placebo/no treatment, Outcome 15 Valaciclovir - additional outcomes.
[Analysis 1.16]
Analysis 1.16. Comparison 1 Antiviral prophylaxis versus placebo/no treatment, Outcome 16 Adverse effects.
[Analysis 2.1]
Analysis 2.1. Comparison 2 Effect of methodological quality on CMV disease in studies of prophylaxis versus placebo/no treatment, Outcome 1 Allocation concealment.
[Analysis 2.2]
Analysis 2.2. Comparison 2 Effect of methodological quality on CMV disease in studies of prophylaxis versus placebo/no treatment, Outcome 2 Blinding of participants/investigators.
[Analysis 2.3]
Analysis 2.3. Comparison 2 Effect of methodological quality on CMV disease in studies of prophylaxis versus placebo/no treatment, Outcome 3 Intention-to-treat analysis (ITT).
[Analysis 2.4]
Analysis 2.4. Comparison 2 Effect of methodological quality on CMV disease in studies of prophylaxis versus placebo/no treatment, Outcome 4 CMV disease by time of outcome assessment or trial publication date.
[Analysis 3.1]
Analysis 3.1. Comparison 3 Effect of methodological quality on all-cause mortality in studies of prophylaxis versus placebo/no treatment, Outcome 1 Allocation concealment.
[Analysis 3.2]
Analysis 3.2. Comparison 3 Effect of methodological quality on all-cause mortality in studies of prophylaxis versus placebo/no treatment, Outcome 2 Blinding of participants and investigators.
[Analysis 3.3]
Analysis 3.3. Comparison 3 Effect of methodological quality on all-cause mortality in studies of prophylaxis versus placebo/no treatment, Outcome 3 Intention-to-treat analysis (ITT).
[Analysis 3.4]
Analysis 3.4. Comparison 3 Effect of methodological quality on all-cause mortality in studies of prophylaxis versus placebo/no treatment, Outcome 4 All-cause mortality and time of outcome assessment or trial publication date.
[Analysis 4.1]
Analysis 4.1. Comparison 4 Ganciclovir versus aciclovir, Outcome 1 CMV disease and CMV infection in all treated patients.
[Analysis 4.2]
Analysis 4.2. Comparison 4 Ganciclovir versus aciclovir, Outcome 2 CMV antibody +ve recipients.
[Analysis 4.3]
Analysis 4.3. Comparison 4 Ganciclovir versus aciclovir, Outcome 3 CMV +ve donors / CMV -ve recipients.
[Analysis 4.4]
Analysis 4.4. Comparison 4 Ganciclovir versus aciclovir, Outcome 4 CMV -ve donor / CMV -ve recipient.
[Analysis 4.5]
Analysis 4.5. Comparison 4 Ganciclovir versus aciclovir, Outcome 5 Effect of prophylaxis for different transplanted organs.
[Analysis 4.6]
Analysis 4.6. Comparison 4 Ganciclovir versus aciclovir, Outcome 6 Death.
[Analysis 4.7]
Analysis 4.7. Comparison 4 Ganciclovir versus aciclovir, Outcome 7 Additional outcomes.
[Analysis 5.1]
Analysis 5.1. Comparison 5 Ganciclovir / aciclovir versus ganciclovir, Outcome 1 CMV disease and CMV infection in all treated patients.
[Analysis 5.2]
Analysis 5.2. Comparison 5 Ganciclovir / aciclovir versus ganciclovir, Outcome 2 Death.
[Analysis 5.3]
Analysis 5.3. Comparison 5 Ganciclovir / aciclovir versus ganciclovir, Outcome 3 Additional outcomes.
[Analysis 6.1]
Analysis 6.1. Comparison 6 Valganciclovir versus ganciclovir, Outcome 1 CMV disease or infection in CMV donor +ve / recipient -ve.
[Analysis 6.2]
Analysis 6.2. Comparison 6 Valganciclovir versus ganciclovir, Outcome 2 Death.
[Analysis 6.3]
Analysis 6.3. Comparison 6 Valganciclovir versus ganciclovir, Outcome 3 Additional outcomes.
[Analysis 7.1]
Analysis 7.1. Comparison 7 Valaciclovir versus ganciclovir or valganciclovir, Outcome 1 CMV disease and CMV infection in all treated patients.
[Analysis 7.2]
Analysis 7.2. Comparison 7 Valaciclovir versus ganciclovir or valganciclovir, Outcome 2 Death.
[Analysis 7.3]
Analysis 7.3. Comparison 7 Valaciclovir versus ganciclovir or valganciclovir, Outcome 3 Additional outcomes.
[Analysis 7.4]
Analysis 7.4. Comparison 7 Valaciclovir versus ganciclovir or valganciclovir, Outcome 4 Renal function at end of study.
[Analysis 8.1]
Analysis 8.1. Comparison 8 Different ganciclovir regimens, Outcome 1 IV doses given at different frequencies.
[Analysis 8.2]
Analysis 8.2. Comparison 8 Different ganciclovir regimens, Outcome 2 Oral versus IV ganciclovir.
[Analysis 9.1]
Analysis 9.1. Comparison 9 Extended duration compared with three months of valganciclovir, Outcome 1 CMV disease.
[Analysis 9.2]
Analysis 9.2. Comparison 9 Extended duration compared with three months of valganciclovir, Outcome 2 CMV syndrome.
[Analysis 9.3]
Analysis 9.3. Comparison 9 Extended duration compared with three months of valganciclovir, Outcome 3 CMV invasive disease.
[Analysis 9.4]
Analysis 9.4. Comparison 9 Extended duration compared with three months of valganciclovir, Outcome 4 CMV infection.
[Analysis 9.5]
Analysis 9.5. Comparison 9 Extended duration compared with three months of valganciclovir, Outcome 5 All-cause mortality.
[Analysis 9.6]
Analysis 9.6. Comparison 9 Extended duration compared with three months of valganciclovir, Outcome 6 Graft loss.
[Analysis 9.7]
Analysis 9.7. Comparison 9 Extended duration compared with three months of valganciclovir, Outcome 7 Acute rejection.
[Analysis 9.8]
Analysis 9.8. Comparison 9 Extended duration compared with three months of valganciclovir, Outcome 8 Other outcomes.
[Analysis 9.9]
Analysis 9.9. Comparison 9 Extended duration compared with three months of valganciclovir, Outcome 9 Adverse effects.