Clinical values of preemptive therapy versus universal prophylaxis in the prevention of cytomegalovirus infection post kidney transplantation: a systematic review and Meta-analysis

Objective To evaluate the clinical efficacy of preemptive therapy versus universal prophylaxis in prevention of cytomegalovirus(CMV) infection post kidney transplantation. Methods Databases including the PubMed, EMbase, sinoMed, Web of Knowledge, the Cochrane Central Register of Controlled Trails (CENTRAL) and other databases were searched up to December 2016 for controlled clinical studies which involved preemptive therapy and universal prophylaxis. Odds ratio (OR) and mean difference (MD) with 95% confidence interval (CI) was performed using Review Manager 5.3 software to synthesize the results. Results 11 studies with a total of 2 560 patients were included in this Meta-analysis. Results showed that universal prophylaxis was superior to preemptive therapy in the total CMV infection and CMV disease(OR=3.38, 95%CI 2.13-5.36, P<0.001; OR=1.69, 95%CI 1.14-2.48, P=0.008), otherwise it was on the contrary in the late onset CMV infection and CMV disease (OR=0.07, 95%CI 0.02~0.19, P<0.001; OR=0.08, 95%CI 0.01-0.60, P=0.01). However, there was no significance in the short outcomes between the two groups including 1-year recipient and graft survival and renal function. In addition, preemptive therapy was superior to universal prophylaxis in the adverse events (OR=0.33, 95%CI 0.15-0.72, P=0.006). Conclusions There was no significant difference between the two prophylaxis in the prevention of CMV infection, but preemptive therapy was superior to universal prophylaxis in the prevention of anti-virus adverse effects. Key words: Kidney transplantation; Cytomegalovirus infection; Preemptive therapy; Universal prophylaxis; Meta-analysis