“Efficacy and safety of conventional antiviral agents in preventive strategies for cytomegalovirus infection after kidney transplantation: a systematic review and network meta-analysis”

BACKGROUND: Cytomegalovirus (CMV) infection is common in kidney transplantation (KT). Antiviral-agents are used as universal prophylaxis. Our purpose aimed to compare and rank efficacy and safety.

METHOD: MEDLINE, Embase, SCOPUS, and CENTRAL were used from inception to September 2020 regardless language restriction. We included randomized clinical trials (RCTs) comparing the CMV infection/disease prophylaxis among antiviral-agents in adult KT recipients.

RESULT: Of 24 eligible RCTs, prophylactic valganciclovir could significantly lower the overall CMV infection and disease risks than placebo with pooled risk differences (RDs) (95% confidence interval (CI)) of -0.36(-0.54, -0.18) and -0.28(-0.48, -0.08), respectively. Valacyclovir and ganciclovir significantly decreased risks with the corresponding RDs of -0.25(-0.32, -0.19) and -0.30(-0.37, -0.22) for CMV infection and -0.26(-0.40, -0.12) and -0.22(-0.31, -0.12) for CMV disease. For subgroup analysis by seropositive-donor and seronegative-recipient (D+/R-), valganciclovir and ganciclovir significantly lowered the risk of CMV infection/disease with RDs of -0.42 (-0.84, -0.01) and -0.35 (-0.60, -0.12). For pre-emptive strategies, ganciclovir lowered the incidence of CMV disease significantly with pooled RDs of -0.33 (-0.47, -0.19).

CONCLUSIONS: Valganciclovir may be the best in prophylaxis of CMV infection/disease follow by ganciclovir. Valacyclovir might be an alternative where valganciclovir and ganciclovir are not available.