Hodson Elisabeth M, Jones Cheryl A, Webster Angela C, Strippoli Giovanni F M, Barclay Peter G, Kable Kathy, Vimalachandra Dushyanthi, Craig Jonathan C
National Health and Medical Research Council Centre for Clinical Research Excellence, Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, Australia.
Lancet. 2005;365(9477):2105-15. doi: 10.1016/S0140-6736(05)66553-1.
Antiviral prophylaxis is commonly used in recipients of solid-organ transplants with the aim of preventing the clinical syndrome associated with cytomegalovirus infection. We undertook a systematic review to investigate whether this approach affects risks of cytomegalovirus disease and death.
Randomised controlled trials of prophylaxis with antiviral medications for cytomegalovirus disease in solid-organ-transplant recipients were identified. Data were combined in meta-analyses by a random-effects model.
Compared with placebo or no treatment, prophylaxis with aciclovir, ganciclovir, or valaciclovir significantly reduced the risks of cytomegalovirus disease (19 trials, 1981 patients; relative risk 0.42 [95% CI 0.34-0.52]), cytomegalovirus infection (17 trials, 1786 patients; 0.61 [0.48-0.77]), and all-cause mortality (17 trials, 1838 patients; 0.63 [0.43-0.92]), mainly owing to lower mortality from cytomegalovirus disease (seven trials, 1300 patients; 0.26 [0.08-0.78]). Prophylaxis also lowered the risks of disease caused by herpes simplex or zoster virus, bacterial infections, and protozoal infections, but not fungal infection, acute rejection, or graft loss. Meta-regression showed no significant difference in the risk of cytomegalovirus disease or all-cause mortality by organ transplanted or cytomegalovirus serostatus; no conclusions were possible for cytomegalovirus-negative recipients of negative organs. In trials of direct comparisons, ganciclovir was more effective than aciclovir in preventing cytomegalovirus disease. Valganciclovir and intravenous ganciclovir were as effective as oral ganciclovir.
Prophylaxis with antiviral medications reduces the risk of cytomegalovirus disease and associated mortality in recipients of solid-organ transplants. This approach should be used routinely in cytomegalovirus-positive recipients and in cytomegalovirus-negative recipients of organs positive for the virus.
抗病毒预防常用于实体器官移植受者，目的是预防与巨细胞病毒感染相关的临床综合征。我们进行了一项系统评价，以研究这种方法是否会影响巨细胞病毒疾病和死亡风险。
确定了针对实体器官移植受者巨细胞病毒疾病进行抗病毒药物预防的随机对照试验。数据通过随机效应模型进行荟萃分析合并。
与安慰剂或不治疗相比，使用阿昔洛韦、更昔洛韦或伐昔洛韦进行预防可显著降低巨细胞病毒疾病风险（19项试验，1981例患者；相对风险0.42[95%CI0.34-0.52]）、巨细胞病毒感染风险（17项试验，1786例患者；0.61[0.48-0.77]）和全因死亡率（17项试验，1838例患者；0.63[0.43-0.92]），主要是由于巨细胞病毒疾病导致的死亡率降低（7项试验，1300例患者；0.26[0.08-0.78]）。预防还降低了单纯疱疹或带状疱疹病毒、细菌感染和原生动物感染引起的疾病风险，但未降低真菌感染、急性排斥或移植物丢失风险。荟萃回归显示，按移植器官或巨细胞病毒血清学状态划分，巨细胞病毒疾病风险或全因死亡率无显著差异；对于巨细胞病毒阴性的器官的巨细胞病毒阴性受者，无法得出结论。在直接比较试验中，更昔洛韦在预防巨细胞病毒疾病方面比阿昔洛韦更有效。缬更昔洛韦和静脉注射更昔洛韦与口服更昔洛韦效果相同。
抗病毒药物预防可降低实体器官移植受者巨细胞病毒疾病风险及相关死亡率。这种方法应常规用于巨细胞病毒阳性受者以及病毒阳性器官的巨细胞病毒阴性受者。
