Clinical Outcomes with Antiviral Prophylaxis or Preemptive Therapy for Cytomegalovirus Disease after Liver Transplantation: A Systematic Review and Meta-Analysis

Abstract

Objectives：We conducted a systematic review and meta-analysis to compare the clinical outcomes of patients after liver transplantation accepting antiviral prophylaxis (AP) or preemptive therapy (PT) for preventing cytomegalovirus (CMV) disease. Methods: A literature search of PubMed, Cochrane, Embase was conducted up to June 1, 2016. References of the retrieved articles were also reviewed and relevant studies were included. The primary outcomes were incidence of CMV infection, incidence of CMV disease, mortality and opportunistic infection. The second outcomes were the mean time to CMV infection and CMV disease, adverse drug reaction (ADR). Sensitivity analysis and publication bias were evaluated. Results: 6 cohort studies involving 1091 liver-transplant recipients (LTRs) were included. All studies were with high quality according to Newcastle-Ottawa Scales (NOS). Incidence of CMV infection and CMV disease showed significant difference between the AP and PT in high-risk patients. There was no significant difference of CMV-related mortality (725 patients, OR 1.27, 95%CI 0.12-13.47, p=0.84) and other opportunistic infections (311 patients, OR 0.85, 95%CI 0.49-1.45, p=0.55) in all “at-risk” patients between the two strategies, whereas late-onset CMV infection and CMV disease were found in patients receiving AP. Conclusion: We recommended the use of AP instead of PT in the high risk patients, and PT could be used in moderate or low risk patients for the similar clinical outcomes in preventing CMV disease. RCTs comparing the two strategies are warranted. This article is open to POST-PUBLICATION REVIEW. Registered readers (see “For Readers”) may comment by clicking on ABSTRACT on the issue’s contents page.