Antiviral Prophylaxis Versus Preemptive Therapy to Prevent Cytomegalovirus Infection and Related Death in Liver Transplantation: A Retrospective Study With Propensity Score Matching

Kim, S.I.; Kim, C.J.; Kim, Y.J.; Son, Hee Jeong; Kim, Y.E.; Kim, M.S.; Hwang, Shin; Kim, J.I.; You, Yong‐Ouk; Kim, D.G.; Kang, Moon‐Won

doi:10.1016/j.transproceed.2012.01.073

Cited by 10 publications

(13 citation statements)

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“…We excluded 41 full-text articles for not meeting our inclusion criteria or those with an insufficient data. The remaining 11 full-text studies ( 9 – 12 , 19 – 25 ), with a total of 1834 LT patients were eligible for this meta-analysis ( Figure 1 ). Table 1 shows the main characteristics of the eligible studies included in our meta-analysis.…”

Section: Resultsmentioning

confidence: 99%

Antiviral prophylaxis or preemptive therapy for cytomegalovirus after liver transplantation?: A systematic review and meta-analysis

et al. 2022

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BackgroundTo conduct a meta-analysis with the aim of comparing the outcomes of antiviral prophylaxis and preemptive therapy for the prevention of cytomegalovirus (CMV) infection in liver transplant (LT) recipients.MethodsWe searched databases for qualified studies up until March 2022. Finally, a meta-analysis was carried out using a fixed-effect or random-effect model based on the heterogeneity.ResultsWith a total of 1834 LT patients, the pooled incidence of CMV infection and CMV disease in the overall LT recipients using antiviral prophylaxis and preemptive therapy were 24.7% vs. 40.4% and 6.4% vs. 9.4%, respectively. Our meta-analysis exhibited a significant reduction in the incidence of CMV infection due to antiviral prophylaxis when compared to preemptive therapy in the high-risk group (OR: 6.67, 95% CI: 1.73, 25.66; p = 0.006). In contrast, there was a significant reduction in the incidence of late-onset of CMV disease in preemptive therapy compared to antiviral prophylaxis in the high-risk group (OR: 0.29, 95% CI: 0.12, 0.74; p = 0.009). However, the incidence of CMV disease, allograft rejection, graft loss, drug related adverse effects, opportunistic infections and mortality did not differ significantly between both the interventions (all p> 0.05).ConclusionsWe found the use of antiviral prophylaxis, compared with preemptive therapy, is superior in controlling CMV infection and prolonging the time to CMV disease in LT recipients without an increased risk of opportunistic infections, allograft rejection, graft loss, drug related adverse effects, development of drug resistance, and mortality.

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Section: Resultsmentioning

confidence: 99%

Antiviral prophylaxis or preemptive therapy for cytomegalovirus after liver transplantation?: A systematic review and meta-analysis

et al. 2022

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“…Three studies reported CMV-related mortality (12)(13)(14). There was no significant difference between the two studies (725 patients, OR 1.27, 95%CI 0.12-13.47, p=0.84; Figure 5).…”

Section: Mortalitymentioning

confidence: 95%

“…The funnel plot did not show obvious asymmetry, and there was no publication bias presented by Egger's test (p=0.349). The results of sensitivity analysis showed substantial modification of the estimates after exclusion of one study (Kim 2012) which showed that the result was not reliable (529 patients, OR 0.45, 95%CI 0.22-0.91, p=0.03).…”

Section: Incidence Of CMV Infectionmentioning

confidence: 96%

“…Five studies reported all-cause mortality (7-9), (13), (14). The pooled incidence rate of all-cause mortality with AP and PT significantly differ (1001 patients, OR 0.69, 95%CI 0.49-0.97, p=0.03; Figure 4).…”

Section: Mortalitymentioning

confidence: 99%

“…151 articles were excluded after full-text review. Overall, 6 studies involving 1091 LTRs were identified (7-9), (12)(13)(14). A total of 534 and 557 LTRs were received AP and PT, respectively.…”

Section: Literature Searchmentioning

confidence: 99%

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

et al. 2017

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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.

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Association between ED crowding and delay in resuscitation effort

Hong

Shin

Song

et al. 2013

The American Journal of Emergency Medicine

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Antiviral Prophylaxis Versus Preemptive Therapy to Prevent Cytomegalovirus Infection and Related Death in Liver Transplantation: A Retrospective Study With Propensity Score Matching

Cited by 10 publications

References 9 publications

Antiviral prophylaxis or preemptive therapy for cytomegalovirus after liver transplantation?: A systematic review and meta-analysis

Antiviral prophylaxis or preemptive therapy for cytomegalovirus after liver transplantation?: A systematic review and meta-analysis

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

Association between ED crowding and delay in resuscitation effort

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