A direct and indirect comparison meta-analysis on the efficacy of cytomegalovirus preventive strategies in solid organ transplant

Abstract

Background. Prophylactic and preemptive strategies are used to prevent cytomegalovirus (CMV) infections after solid organ transplant. We assessed the safety and efficacy of both strategies for CMV prevention.Methods. A DerSimonian and Laird random-effects model was used for pooling the data, and Q statistic and I2 methods were used to assess statistical heterogeneity.Results. Twenty studies (2744 patients) were selected for the direct analysis and 20 studies (2544 patients) for the indirect analysis. The odds of CMV syndrome (odds ratio [OR] = 1.10; 95% confidence interval [CI],. 60-2.03; P =. 757; Q = 18.55; I2 = 51.5%) and disease (OR = 0.77; 95% CI,. 41-1.47; P =. 432; Q = 32.71; I2 = 45.0%) were not significantly different between strategies. The odds of developing late-onset CMV infections were higher for the prophylactic compared to the preemptive strategy (OR = 6.21; 95% CI, 2.55-15.20; P