CMV-hyperimmune globulin for preventing cytomegalovirus infection and disease in solid organ transplant recipients: a meta-analysis.
OBJECTIVE
The goal of this meta-analysis was to investigate the impact of cytomegalovirus hyperimmune globulin (CMVIG) on cytomegalovirus (CMV) infection, CMV disease, and mid-term survival in solid organ transplant recipients.


METHODS
Medline, EMBASE, and the Cochrane databases were searched since their inceptions until 2006. Inclusion criteria comprised: prospective randomized trials, in solid organ transplantation which received CMV prophylaxis including CMVIG on one of the treatment arms. 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 Funnel plot was used to assess publication bias.


RESULTS
Literature searches identified 11 randomized trials (698 patients; median follow-up: 12 months, range: 3-22 months) including six randomized trials (302 patients) after kidney transplantation. The analysis demonstrated a beneficial effect of the prophylactic use of CMVIG on total survival [RR (95% confidence interval; 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)]. CMV disease was significantly reduced in all recipients receiving prophylactic CMVIG [RR (95% CI): 0.697 (0.57-0.85)]. CMVIG had no impact on CMV-infections and clinically relevant rejections.


CONCLUSIONS
Prophylactic administration of CMVIG after solid organ transplantation is associated with improved total survival, reduced CMV disease, and CMV-associated deaths.
Bonaros
Nikolaos
N
Department of Cardiac Surgery, Innsbruck, Medical University, Innsbruck, Austria. nikolaos.bonaros@i-med.ac.at
Mayer
Bernd
B
Schachner
Thomas
T
Laufer
Günther
G
Kocher
Alfred
A
D003586:Cytomegalovirus Infections / Q000517:prevention & control*; D006084:Graft Rejection / Q000453:epidemiology; D016027:Heart Transplantation; D006801:Humans; D007116:Immunization, Passive; D007136:Immunoglobulins / Q000627:therapeutic use*; D016756:Immunoglobulins, Intravenous; D016030:Kidney Transplantation; D016040:Lung Transplantation; D016377:Organ Transplantation; D011183:Postoperative Complications / Q000517:prevention & control*; D016032:Randomized Controlled Trials as Topic
D007136:Immunoglobulins; D016756:Immunoglobulins, Intravenous; C045781:cytomegalovirus-specific hyperimmune globulin