Epidemiology, management, and burden of cytomegalovirus in solid organ transplant recipients in selected countries outside of Europe and North America: A systematic review

Abstract

BackgroundCytomegalovirus (CMV) is a frequent infectious complication following solid organ transplantation (SOT). Considering significant differences in healthcare systems, a systematic review was conducted to describe the epidemiology, management, and burden of CMV post‐SOT in selected countries outside of Europe and North America.MethodsMEDLINE, Embase, and Cochrane databases were searched for observational studies in SOT recipients across 15 countries in the regions of Asia, Pacific, and Latin America (search period: January 1, 2011 to September 17, 2021). Outcomes included incidence of CMV infection/disease, recurrence, risk factors, CMV‐related mortality, treatment patterns and guidelines, refractory and/or resistant CMV, patient‐reported outcomes, and economic burden.ResultsOf 2708 studies identified, 49 were eligible (n = 43/49; 87.8% in adults; n = 34/49, 69.4% in kidney recipients). Across studies, selection of CMV preventive strategy was based on CMV serostatus. Overall, rates of CMV infection (within 1 year) and CMV disease post‐SOT were respectively, 10.3%–63.2% (9 studies) and 0%–19.0% (17 studies). Recurrence occurred in 35.4%–41.0% cases (3 studies) and up to 5.3% recipients died of CMV‐associated causes (11 studies). Conventional treatments for CMV infection/disease included ganciclovir (GCV) or valganciclovir. Up to 4.4% patients were resistant to treatment (3 studies); no studies reported on refractory CMV. Treatment‐related adverse events with GCV included neutropenia (2%–29%), anemia (13%–48%), leukopenia (11%–37%), and thrombocytopenia (13%–24%). Data on economic burden were scarce. imageConclusionOutside of North America and Europe, rates of CMV infection/disease post‐SOT are highly variable and CMV recurrence is frequent. CMV resistance and treatment‐associated adverse events, including myelosuppression, highlight unmet needs with conventional therapy.

Human Cytomegalovirus (HCMV) Genetic Diversity, Drug Resistance Testing and Prevalence of the Resistance Mutations: A Literature Review

“…Silva Junior et al presented a systematic review of the epidemiology, management, and burden of HCMV post-SOT in selected countries outside of Europe and North America in a 10-year period. The authors selected 49 studies out of 2708 studies and reported that rates of HCMV infection within one year were 10.3–63.2% (9 studies) and 0–19.0% (17 studies), up to 4.4% patients were resistant to treatment (3 studies) and no studies reported on refractory HCMV, which proves that rates of HCMV infection/disease post-SOT are highly variable [ 78 ]. A French two-center study included 81 SOT recipients with refractory HCMV infections monitored during a 10-year period and detected 24 genotypic profiles that conferred resistance to GCV and 2 to GCV and CDV.…”