Cochrane · systematic review · CD003774
Antiviral medications for preventing cytomegalovirus disease in solid organ transplant recipients
Vernooij, RWM, Michael, M, Ladhani, M, et al. · Cochrane Database of Systematic Reviews · 2024 · Cochrane Library
SoF tableOnly the outcomes this review put in its Summary of Findings table are listed (the Cochrane Handbook caps them at about seven per comparison). Its other analyses are not shown here.
Questions
43
current version
GRADE rated
39
No studies
4
Included studies
NR
No studies 4 · 9.3%Ungraded 0 · 0%Very low 1 · 2.3%Low 16 · 37.2%Moderate 16 · 37.2%High 6 · 14%
Ungraded means an effect was reported without a GRADE rating; it is not a gap. No studies means the review found nothing to answer the question. The six categories are a display order, not a score.
Questions and results
Show all 2 versionsAntiviral prophylaxis versus placebo or no treatment for preventing cytomegalovirus disease in solid organ transplant recipients
Population: solid organ transplant recipients
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
CMV disease: all symptomatic CMV disease Antiviral prophylaxis vs placebo or no treatment | RR 0.42 [0.34, 0.52] | 19 studies · 1981 participants | High |
Death due to CMV disease Antiviral prophylaxis vs placebo or no treatment | RR 0.26 [0.08, 0.78] | 7 studies · 1300 participants | Moderate Downgraded: imprecision |
All‐cause death Antiviral prophylaxis vs placebo or no treatment | RR 0.63 [0.43, 0.92] | 17 studies · 1838 participants | High |
CMV infection Antiviral prophylaxis vs placebo or no treatment | RR 0.61 [0.48, 0.77] | 17 studies · 1786 participants | High |
Graft loss Antiviral prophylaxis vs placebo or no treatment | RR 0.74 [0.47, 1.17] | 10 studies · 825 participants | Moderate Downgraded: imprecision |
Acute rejection Antiviral prophylaxis vs placebo or no treatment | RR 0.9 [0.78, 1.05] | 13 studies · 1420 participants | High |
Leucopenia Antiviral prophylaxis vs placebo or no treatment | RR 1.03 [0.67, 1.59] | 4 studies · 1125 participants | Moderate Downgraded: imprecision |
Kidney dysfunction Antiviral prophylaxis vs placebo or no treatment | RR 1.81 [0.88, 3.73] | 5 studies · 668 participants | Low Downgraded: imprecision, inconsistency |
Ganciclovir versus aciclovir for preventing cytomegalovirus disease in solid organ transplant recipients
Population: solid organ transplant recipients
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
CMV disease Ganciclovir vs aciclovir | RR 0.37 [0.23, 0.6] | 7 studies · 1113 participants | High |
Death due to CMV disease Ganciclovir vs aciclovir | RR 0.33 [0.07, 1.58] | 6 studies · 832 participants | Moderate Downgraded: imprecision |
All‐cause death Ganciclovir vs aciclovir | RR 1.13 [0.82, 1.58] | 8 studies · 1138 participants | Moderate Downgraded: imprecision |
Acute rejection Ganciclovir vs aciclovir | RR 0.98 [0.87, 1.1] | 6 studies · 1009 participants | High |
Graft loss Ganciclovir vs aciclovir | RR 0.55 [0.27, 1.13] | 3 studies · 268 participants | Moderate Downgraded: imprecision |
Opportunistic infections: other viral infections Ganciclovir vs aciclovir | RR 0.81 [0.32, 2.01] | 4 studies · 740 participants | Moderate Downgraded: imprecision |
Leucopenia Ganciclovir vs aciclovir | RR 3.28 [1.48, 7.25] | 6 studies · 955 participants | Low Downgraded: imprecision |
Kidney dysfunction Ganciclovir vs aciclovir | RR 0.96 [0.83, 1.1] | 4 studies · 661 participants | Moderate Downgraded: imprecision |
Valaciclovir versus ganciclovir or valganciclovir for preventing cytomegalovirus disease in solid organ transplant recipients
Population: solid organ transplant recipients
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
CMV disease Valaciclovir vs ganciclovir or valganciclovir | RR 0.55 [0.17, 1.74] | 4 studies · 331 participants | Low Downgraded: imprecision |
All‐cause death Valaciclovir vs ganciclovir or valganciclovir | RR 1.97 [0.31, 12.37] | 3 studies · 273 participants | Low Downgraded: imprecision |
CMV infection Valaciclovir vs ganciclovir or valganciclovir | RR 1.31 [0.91, 1.9] | 4 studies · 331 participants | Low Downgraded: imprecision |
Acute rejection Valaciclovir vs ganciclovir or valganciclovir | RR 0.91 [0.22, 3.73] | 3 studies · 271 participants | Very low Downgraded: imprecision |
Graft loss Valaciclovir vs ganciclovir or valganciclovir | RR 0.61 [0.18, 2.02] | 2 studies · 190 participants | Low Downgraded: imprecision, inconsistency |
Leucopenia Valaciclovir vs ganciclovir or valganciclovir | RR 0.74 [0.45, 1.24] | 2 studies · 188 participants | Moderate Downgraded: imprecision, inconsistency |
SCr at the end of Valaciclovir vs ganciclovir or valganciclovir | no estimate extracted | 3 studies · 271 participants | Moderate Downgraded: imprecision, inconsistency |
Extended versus short‐duration valganciclovir for preventing cytomegalovirus disease in solid organ transplant recipients
Population: solid organ transplant recipients
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
CMV disease Extended vs short‐duration valganciclovir | RR 0.2 [0.12, 0.35] | 2 studies · 454 participants | Moderate Downgraded: imprecision |
All‐cause death Extended vs short‐duration valganciclovir | RR 0.09 [0.01, 1.7] | 1 study · 319 participants | Low Downgraded: imprecision, inconsistency |
CMV syndrome Extended vs short‐duration valganciclovir | RR 0.39 [0.24, 0.64] | 2 studies · 454 participants | Moderate Downgraded: imprecision |
CMV infection Extended vs short‐duration valganciclovir | RR 0.27 [0.1, 0.71] | 2 studies · 454 participants | Low Downgraded: imprecision |
Acute rejection Extended vs short‐duration valganciclovir | RR 0.64 [0.43, 0.95] | 2 studies · 454 participants | Moderate Downgraded: imprecision |
Opportunistic infections Extended vs short‐duration valganciclovir | RR 0.71 [0.33, 1.57] | 2 studies · 456 participants | Low Downgraded: imprecision |
Total treatment‐related adverse effects Extended vs short‐duration valganciclovir | RR 1.16 [0.97, 1.4] | 2 studies · 456 participants | Moderate Downgraded: imprecision |
Low versus standard dose valganciclovir for preventing cytomegalovirus disease in solid organ transplant recipients
Population: solid organ transplant recipients
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
All‐cause death Low vs standard dose valganciclovir | RR 0.2 [0.11, 4.11] | 1 study · 196 participants | Low Downgraded: imprecision |
CMV infection Low vs standard dose valganciclovir | RR 0.37 [0.11, 1.22] | 2 studies · 256 participants | Low Downgraded: imprecision |
Acute rejection Low vs standard dose valganciclovir | RR 0.33 [0.07, 1.61] | 1 study · 196 participants | Low Downgraded: imprecision |
Graft loss Low vs standard dose valganciclovir | RR 1 [0.06, 15.76] | 1 study · 196 participants | Low Downgraded: imprecision |
Opportunistic infection Low vs standard dose valganciclovir | no estimate extracted | NR | No studies |
Adverse events Low vs standard dose valganciclovir | no estimate extracted | NR | No studies |
Maribavir versus ganciclovir for preventing cytomegalovirus disease in solid organ transplant recipients
Population: solid organ transplant recipients
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
CMV disease Maribavir vs ganciclovir | RR 1.3 [0.74, 2.29] | 1 study · 233 participants | Low Downgraded: imprecision |
All‐cause death Maribavir vs ganciclovir | RR 1.5 [0.55, 4.11] | 1 study · 294 participants | Low Downgraded: imprecision |
CMV infection Maribavir vs ganciclovir | RR 1.34 [1.1, 1.65] | 1 study · 233 participants | Moderate Downgraded: imprecision |
Acute rejection Maribavir vs ganciclovir | RR 0.92 [0.53, 1.61] | 1 study · 303 participants | Low Downgraded: imprecision |
Graft loss Maribavir vs ganciclovir | no estimate extracted | NR | No studies |
Opportunistic infection Maribavir vs ganciclovir | no estimate extracted | NR | No studies |
Adverse events Maribavir vs ganciclovir | RR 0.99 [0.79, 1.25] | 1 study · 303 participants | Moderate Downgraded: imprecision |