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Evidence summaries

Pre-Emptive Antiviral Treatment to Prevent Cytomegalovirus Disease in Solid Organ Transplant Recipients

Pre-emptive treatment with antiviral agents for solid organ transplant recipients reduces the risk of cytomegalovirus disease when compared to placebo or standard care. The outcomes are similar to routine prophylactic antiviral therapy. Level of evidence: "A"

A Cochrane review [Abstract] 1 included 22 studies on pre-emptive treatment, i.e. treatment only when there is evidence of CMV infection during routine screening, with a total of 1883 subjects. Compared with placebo or standard care, pre-emptive treatment reduced the risk of CMV disease (RR 0.29, 95% CI 0.11 to 0.80; 7 studies, n=315: I²=54%) but not acute rejection or all-cause mortality (3 trials, 176 patients: RR 1.23, 95% CI 0.35 to 4.30). Comparative trials of pre-emptive therapy versus prophylaxis showed no significant difference in the risks of CMV disease (RR 0.97, 95% CI 0.47 to 2.01; 11 studies, n=1322; I²=54%). Leucopenia was significantly less common with pre-emptive therapy compared with prophylaxis (RR 0.57, 95% CI 0.38 to 0.87; 7 studies, n=869: I²=33%). There were no significant differences in the risks of acute rejection, all-cause mortality, or graft loss.

    References

    • Vernooij RW, Michael M, Colombijn JM, et al. Pre-emptive treatment for cytomegalovirus viraemia to prevent cytomegalovirus disease in solid organ transplant recipients. Cochrane Database Syst Rev 2025;1(1):CD005133.[PubMed]

Primary/Secondary Keywords