Preventing Post–Organ Transplantation Cytomegalovirus Disease with Ganciclovir: A Meta‐Analysis Comparing Prophylactic and Preemptive Therapies

Small, Lorne N.; Lau, Joseph; Snydman, David R.

doi:10.1086/507337

Cited by 140 publications

(99 citation statements)

References 48 publications

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“…Reassuringly, clinical trials have demonstrated the efficacy of preemptive therapy in CMV disease prevention [54][55][56]59] . Three meta-analyses that collectively analyzed data from prospective clinical trials confirmed the efficacy and benefits of preemptive therapy in the prevention of CMV disease [34,35,62] . When conducted properly, preemptive therapy, with the use of oral ganciclovir, IV ganciclovir, or valganciclovir resulted in reduction of CMV disease by about 70% [34,35,62] .…”

Section: Preemptive Therapymentioning

confidence: 91%

“…CMV was a major cause of mortality after liver transplantation prior to the availability of intravenous (IV) and oral ganciclovir. Several recent meta-analyses have demonstrated that the use of anti-CMV drugs, either through antiviral prophylaxis or preemptive therapy, have led to significant reduction in the overall mortality after solid organ transplantation [19,[33][34][35] . However, despite much improvement in outcome, there is emerging data to suggest that even in the contemporary era, with widespread use of antiviral prophylaxis, development of delayed onset CMV disease remains a common problem, and importantly, is associated with significantly increased risk of mortality after liver transplantation [32] .…”

Section: Impact On Mortalitymentioning

confidence: 99%

See 1 more Smart Citation

Cytomegalovirus infection after liver transplantation: Current concepts and challenges

Razonable

2008

WJG

181

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Section: Preemptive Therapymentioning

confidence: 91%

Section: Impact On Mortalitymentioning

confidence: 99%

Cytomegalovirus infection after liver transplantation: Current concepts and challenges

Razonable

2008

WJG

181

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“…Three metaanalyses that collecti vely analyzed data from prospective clinical trials demonstrated the benefits of preempti ve therapy in preventing CMV dis ease [35,36,68] . When conducted properly, preempti ve therapy, with the use of oral ganciclovir, IV ganciclovir, or val ganciclovir resulted in the reduction of CMV disease by about 70% [35,36,68] . Moreover, preemptive therapy is much less likely associated with late onset CMV disease (unlike in antiviral prophylaxis, as discussed below) [59,66] .…”

Section: Preemptive Therapymentioning

confidence: 99%

“…Anti viral prophylaxis is highly effecti ve in preventing the direct, as well as the indirect effects of CMV after li ver transplantation [4,5,35,36,68] . Compared to placebo or no treat ment, patients who received antiviral prophylaxis had lower incidence of CMV disease (58%80% reduction) and CMV infection (about 40% reduction) [68] .…”

Section: Antiviral Prophylaxismentioning

confidence: 99%

Current concepts on cytomegalovirus infection after liver transplantation

Lee

Razonable

2010

WJH

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Cytomegalovirus (CMV) is the most common viral pathogen that negatively impacts on the outcome of liver transplantation. CMV cause febrile illness often accompanied by bone marrow suppression, and in some cases, invades tissues including the transplanted allograft. In addition, CMV has been significantly asso ciated with an increased predisposition to allograft rejection, accelerated hepatitis C recurrence, and other opportunistic infections, as well as reduced overall pa tient and allograft survival. To negate the adverse effects of CMV on outcome, its prevention, whether through antiviral prophylaxis or preemptive therapy, is regarded as an essential component to the medical management of liver transplant patients. Two recent guidelines have suggested that antiviral prophylaxis or preemptive therapy are similarly effective in preventing CMV disease in modest-risk CMV-seropositive liver trans plant recipients, while antiviral prophylaxis is the preferred strategy over preemptive therapy for the preven tion of CMV disease in high-risk recipients [CMV-seronegative recipients of liver allografts from CMV-seropositive donors (D+/R-)]. However, antiviral prophylaxis has only delayed the onset of CMV disease in many CMV D+/R-liver transplant recipients, and at least in one study, such occurrence of late-onset primary CMV disease was significantly associated with increased mortality after liver transplantation. Therefore, optimized strategies for prevention are needed, and aggressive treatment of CMV infection and disease should be pursued. The standard treatment of CMV disease consists of intravenous ganciclovir or oral valganciclovir, and if feasible, one should also reduce the degree of immunosuppression. In one recent controlled clinical trial, val ganciclovir was found to be as effective and safe as intravenous ganciclovir for the treatment of mild to mo derate CMV disease in solid organ (including liver) tran splant recipients. In this article, the authors review the current state and the future perspectives of prevention and treatment of CMV disease after liver transplantation.

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“…While prophylaxis has been associated with superior graft and patient survival [18,19], as well as cost and quality of life benefits [20] compared to a preemptive strategy, the latter may be appropriate for patients at risk for CMV disease with contraindications to oral valganciclovir therapy [17,21]. In such an approach, monitoring of the serum C-MV PCR is conducted at regular intervals (often weekly) to detect infections before tissue-invasive disease results [17].…”

Section: Discussionmentioning

confidence: 99%

A Case of Cytomegalovirus-Induced Arthritis after Lymphocyte-Depleting Therapy for Kidney Allograft Rejection

Fuquay¹,

Cooper²

2012

OJNeph

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Cytomegalovirus viremia and tissue-invasive disease are common after kidney transplantation. Chemoprophylaxis has made substantial improvement in this clinical problem. Here we report a 29-year-old woman who had kidney allograft rejection and received lymphocyte-depleting therapy. She presented with a new oligo-arthritis that led to 2 successive arthrocenteses. The etiology of the inflammation could not be determined initially. On the second arthrocentesis, a synovial fluid cytomegalovirus polymerase chain reaction test was positive. The patient responded to treatment with valganciclovir, had negative follow-up serum cytomegalovirus polymerase chain reaction tests, and experienced resolution of her joint inflammation. We review briefly the data for cytomegalovirus chemoprophylaxis, preemptive screening, and treatment recommendations.

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Preventing Post–Organ Transplantation Cytomegalovirus Disease with Ganciclovir: A Meta‐Analysis Comparing Prophylactic and Preemptive Therapies

Abstract: On the basis of indirect comparisons of meta-analyses of prevention strategies, universal prophylaxis and preemption are equally effective in reducing the incidence of CMV disease.

Cited by 140 publications

References 48 publications

Cytomegalovirus infection after liver transplantation: Current concepts and challenges

Cytomegalovirus infection after liver transplantation: Current concepts and challenges

Current concepts on cytomegalovirus infection after liver transplantation

A Case of Cytomegalovirus-Induced Arthritis after Lymphocyte-Depleting Therapy for Kidney Allograft Rejection

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