Prevention of cytomegalovirus infection after solid organ transplantation: a Bayesian network analysis

Background Cytomegalovirus infection is one of the most common complications after solid organ transplantation. There have been several classes of antiviral drugs for the prevention of cytomegalovirus infection, such as acyclovir, valacyclovir, ganciclovir and valganciclovir. Methods We searched relevant prospective and multi-armed studies on PubMed from Jan. 1984 up to Mar. 2018. Results Seventeen prospective studies involving 2062 patients were included in the analysis. In the case of cytomegalovirus infection, the ganciclovir group (OR = 0.24, 95% CI 0.09-0.57) and the valacyclovir group (OR = 0.20, 95% CI 0.04-0.69) provided significantly better outcomes than the control group. The ganciclovir (OR = 0.37, 95% CI 0.13-0.86) and valacyclovir groups (OR = 0.31, 95% CI 0.07-0.98) showed moderate superiority compared to the acyclovir group. As for cytomegalovirus disease, the ganciclovir, valacyclovir and valganciclovir groups showed significant advantages compared with the control group (ganciclovir group: OR = 0.17, 95% CI 0.07-0.31, valacyclovir group: OR = 0.08, 95% CI 0.01-0.33, valganciclovir group: OR = 0.14, 95% CI 0.02-0.45). Similarly, the ganciclovir group (OR = 0.38, 95% CI 0.12-0.71) and the valacyclovir group (OR = 0.17, 95% CI 0.03-0.72) showed better results than the acyclovir group. Conclusion Valacyclovir showed to be the most efficient antiviral for the prevention of cytomegalovirus infection and disease. Additional studies are required to evaluate putative side effects associated with valacyclovir administration.