Meta-analysis of CMV-hyperimmune globulin studies for the prevention of CMV infection and disease in solid organ transplant recipients

Objective: Despite numerous studies comparing CMV-immunoglobulins and antiviral agents the optimal prophylaxis of CMV disease after solid organ transplantation remains debated. We conducted a meta-analysis to study the early and mid-term outcomes of CMV-prophylaxis following solid organ transplantation

Methods: Medline, EMBASE, and the Cochrane databases were searched and a hand search of bibliographies was conducted. Random effects models were used to calculate pooled risk ratios (RR) and meta-regression was employed to explain study heterogeneity. Stratified analyses were conducted and a Funnel plot was used to assess publication bias.

Results: Eleven randomized trials (698 patients; median follow-up: 12 months, range: 3–22 months) including 6 randomized trials (302 patients) after kidney transplantation were identified and analyzed separately. The analysis demonstrated a beneficial effect of the prophylactic use of CMVIG on total survival (RR [95% CI]: 0.67 [0.47–0.95]) and prevention of CMV-associated death (RR [95% CI]: 0.45 [0.24–0.84]) in solid organ transplant recipients but not kidney transplant recipients (RR [95% CI]: 0.35 [0.12–1.04]). Analysis of the number of CMV disease revealed a significant benefit solid organ transplant recipients in both analysis groups which received CMVIG as prophylactic therapy (RR [95% CI]: 0.697 [0.57–0.85]. No significant differences were observed in terms of CMV-infections and clinically relevant rejections.

Conclusions: CMVIG for CMV-prophylaxis after solid organ transplantation is associated with improved total survival and reduced CMV-associated deaths and CMV-disease. No benefit can be detected in terms of CMV-infections and clinically relevant rejections.