Résumé
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 Metaanalysis.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％ CI0.02 ～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.
Résumé
Abstract Introduction: Human cytomegalovirus is a major cause of morbidity in kidney transplant patients. Objectives: We aimed to study viral replication and serological response in the first months post kidney transplant in patients undergoing universal prophylaxis or preemptive therapy and correlate the findings with the clinical course of Human cytomegalovirus infection. Patients and methods: Independent from the clinical strategy adopted for managing Human cytomegalovirus infection, prophylaxis versus preemptive therapy, the pp65 antigenemia assay and serological response were assessed on the day of transplantation, and then weekly during the first three months of post-transplant. Results: From the 32 transplant recipients, 16 were positive for pp65 antigenemia, with a similar incidence rate in each group. There were no positive results in the first three weeks of monitoring; the positivity rate peaked at week eight. There was a trend for a higher and earlier frequency of positivity in the universal prophylaxis group in which the course of the Human cytomegalovirus infection was also more severe. Despite the differences in clinical picture and in the initial immunosuppressant schedule, the serological response was similar in both groups. Conclusion: Routine monitoring during the first three post-transplant months has a positive impact on the early detection of Human cytomegalovirus viral replication allowing for timely treatment in order to reduce morbidity of the disease. The strategy of universal therapy employing intravenous ganciclovir was associated to a worse clinical course of the Human cytomegalovirus infection suggesting that the use of >10 cells/2 × 105 leukocytes as a cut-off in this setting may be inappropriate.