Effectiveness of Prophylactic Human Cytomegalovirus Hyperimmunoglobulin in Preventing Cytomegalovirus Infection following Transplantation: A Systematic Review and Meta-Analysis.

Markus J Barten,Alexander Staus,Fausto Baldanti,Christian M Hüber,Andreas Zuckermann,Kyriaki Glynou

doi:10.3390/life12030361

Abstract

Cytomegalovirus (CMV) is a common infection occurring in patients undergoing solid organ transplantation (SOT) or hematopoietic stem cell transplantation (HSCT). CMV-specific hyperimmunoglobulin (CMVIG) has been used for the past four decades and is typically administered either prophylactically or pre-emptively. The present meta-analysis evaluated CMV infection rates in SOT patients who received prophylactic CMVIG. PubMed and the Cochrane Library were searched for studies published up to October 2021. The primary endpoint was CMV infection rate. Thirty-two SOT studies were identified (n = 1521 CMVIG-treated and n = 1196 controls). Prophylactic CMVIG treatment was often associated with a lower risk of CMV infection in transplant recipients. The average CMV infection rate was 35.8% (95% confidence interval [CI]: 33.4–38.2%) in patients treated prophylactically with CMVIG and 41.4% (95% CI: 38.6–44.2%) in the control group not receiving CMVIG (p = 0.003). Similar results were observed in analyses limited to publications evaluating currently available CMVIG products (Cytotect CP and Cytogam; p < 0.001). In combination with the established safety profile for CMVIG, these results suggest that prophylactic CMVIG treatment in patients undergoing solid organ transplantation may be beneficial, particularly in those at high risk of CMV infection or disease.

Highlights

The most frequently used prophylactic CMV-specific hyperimmunoglobulin (CMVIG) regimen involved the administration of 150 mg/kg within 72 h of transplantation and every 2 weeks thereafter
Ininfection and its associated complications for four decades, and yet there have been few fection and its associated complications for four decades, and yet there have been few recent recent analyses on the efficacy of CMVIG in the prevention of CMV infection that take into analyses on the efficacy of CMVIG in the prevention of CMV infection that take into account account the full time period in which CMVIG has been used in the clinical setting
Some reports have suggested that CMVIG may be useful as prophylaxis and as rescue therapy upon the detection of CMV infection, but the current analysis focused on studies evaluating the labeled use in prophylaxis, in which CMVIG prophylaxis was started around the day of transplantation

Summary

Introduction

Cytomegalovirus (CMV) is a common opportunistic pathogen of the Herpesviridae family, with an estimated mean global seroprevalence of 83% in the general population [1]. Seronegative individuals may experience a primary infection followed by a long period of latency [2]. CMV may reactivate or a new strain of CMV may infect the individual. Both infection and reactivation cause minimal or no symptoms in most immunocompetent people, but can lead to uncontrolled viral replication and serious illness in immunocompromised patients. Viremia and viral dissemination to multiple organs can result in end-organ CMV disease, such as pneumonitis, hepatitis, retinitis, mononucleosis, or gastroenteritis [1,3,4]

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