A Cochrane review [Abstract] 1 included 15 studies on pre-emptive treatment, i.e. treatment only when there is evidence of CMV infection during routine screening, with a total of 1098 subjects. Compared with placebo or standard care, pre-emptive treatment significantly reduced the risk of CMV disease (six trials, 288 patients: RR 0.29, 95% CI 0.11 to 0.80) but not acute rejection (three trials, 185 patient: RR 1.06, 95% CI 0.64 to 1.76) 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 (7 studies, 753 participants: RR 1.00, 95% CI 0.36 to 2.74; I² = 63%, 7 trials, n=753). Leucopenia was significantly less common with pre-emptive therapy compared with prophylaxis ( RR 0.42, 95% CI 0.20 to 0.90; 6 studies, n=729). There were no significant differences in the risks of acute rejection, all-cause mortality, or graft loss.
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