Couchoud C
Service de Néphrologie, Centre Hospitalier Départemental Félix Guyon, Bellepierre, St Denis, La Réunion, France, 97400.
Cochrane Database Syst Rev. 2000(2):CD001320. doi: 10.1002/14651858.CD001320.
To assess the efficacy of antiviral agents in solid organ transplant recipients in the prevention of cytomegalovirus infection and symptomatic disease and in the reduction of the incidence of acute rejection, graft loss and death.
A computerised search was conducted on Medline, Embase and Pascal. The reference lists of the current review articles and some congress proceedings were searched manually (Transplantation Proceedings, American Thoracic Society, European Society of Organ Transplantation).
Prospective, randomised studies in adults or paediatric recipients of a solid organ transplant, in which one arm received a prophylactic treatment with acyclovir and/or ganciclovir, started before cytomegalovirus infection, and the control arm received placebo or no treatment.
Data were extracted from each trial and a letter sent to the authors to ask them to verify the data extracted, and to provide any data that was missing. For each outcome, several methods were used to calculate the chi-square for association and the estimate for the treatment effect with its 95% confidence interval, with an additive model (rate difference), or a multiplicative model (odds ratio, relative risk). We considered the test of association to be significant when the p value was less than 0.01 and the homogeneity test to be significant when the p value was less than 0.1.
Prophylactic treatment was found to be associated with a significant decrease in cytomegalovirus disease compared with placebo or no treatment, using the logarithm of relative risk method (relative risk 0.51, 95% confidence interval 0. 41-0.64, p value for X(2) association < 0.001). Prophylactic treatment also decreased the rate of cytomegalovirus infection (RR 0. 62, 95%CI 0.53-0.73, p < 0.001). Our analysis failed to show a significant decrease in graft loss, acute rejection or death in the prophylactic treatment group. Sub-group analysis based on the type of antiviral agent (acyclovir or ganciclovir) and on the type of organ (kidney or liver) gave comparable results.
REVIEWER'S CONCLUSIONS: The use of antiviral agents for the prevention of cytomegalovirus disease and cytomegalovirus infection in solid organ transplantation is supported by this meta-analysis.
评估抗病毒药物在实体器官移植受者中预防巨细胞病毒感染及症状性疾病，以及降低急性排斥反应、移植物丢失和死亡发生率的疗效。
对Medline、Embase和Pascal进行计算机检索。人工检索当前综述文章的参考文献列表以及一些会议论文集（《移植会议论文集》、美国胸科学会、欧洲器官移植学会）。
针对实体器官移植的成人或儿童受者开展的前瞻性随机研究，其中一组在巨细胞病毒感染前开始接受阿昔洛韦和/或更昔洛韦的预防性治疗，对照组接受安慰剂或不治疗。
从每项试验中提取数据，并致函作者请他们核实提取的数据，并提供任何缺失的数据。对于每个结局，使用多种方法计算关联的卡方值以及治疗效果的估计值及其95%置信区间，采用相加模型（率差）或相乘模型（比值比、相对危险度）。当p值小于0.01时，我们认为关联检验具有显著性；当p值小于0.1时，我们认为齐性检验具有显著性。
与安慰剂或不治疗相比，采用相对危险度对数法发现预防性治疗与巨细胞病毒疾病显著减少相关（相对危险度0.51，95%置信区间0.41 - 0.64，X(2)关联的p值<0.001）。预防性治疗还降低了巨细胞病毒感染率（RR 0.62，95%CI 0.53 - 0.73，p<0.001）。我们的分析未能显示预防性治疗组在移植物丢失、急性排斥反应或死亡方面有显著降低。基于抗病毒药物类型（阿昔洛韦或更昔洛韦）和器官类型（肾脏或肝脏）的亚组分析得出了类似的结果。
该荟萃分析支持在实体器官移植中使用抗病毒药物预防巨细胞病毒疾病和巨细胞病毒感染。
