Epidemiology, risk factors, and outcomes associated with cytomegalovirus in adult kidney transplant recipients: A systematic literature review of real‐world evidence

Kidney transplant recipients (KTRs) have increased risk for cytomegalovirus (CMV) infection/disease given the necessity of drug‐induced immunosuppression. A comprehensive review of published literature reporting real‐world data on prevention strategies utilized and associated CMV burden outcomes is...

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Bibliographic Details
Published in:Transplant infectious disease 2021-04, Vol.23 (2), p.e13483-n/a
Main Authors: Raval, Amit D., Kistler, Kristin D., Tang, Yuexin, Murata, Yoshihiko, Snydman, David R.
Format: Article
Language:English
Subjects:
antiviral preemptive therapy
antiviral prophylaxis
Cytomegalovirus
Epidemiology
Ganciclovir
Graft rejection
Health risks
Heterogeneity
Immunosuppression
Infections
Kidney transplantation
Kidney transplants
Kidneys
Literature reviews
Preempting
Prevention
Prophylaxis
real‐world evidence
Risk analysis
Risk factors
systematic literature review
Transplants
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Summary:Kidney transplant recipients (KTRs) have increased risk for cytomegalovirus (CMV) infection/disease given the necessity of drug‐induced immunosuppression. A comprehensive review of published literature reporting real‐world data on prevention strategies utilized and associated CMV burden outcomes is limited. Such data could help inform future clinical practice and identify unmet needs in CMV management. We conducted a systematic review of observational studies published in Medline or EMBASE from January 2008 to November 2018 to identify current real‐world CMV management approaches, CMV infection/disease risk factors, and outcomes associated with CMV infection. Descriptive statistics and pooled quantitative analyses were conducted. From 1608 records screened, 86 citations, including 69 803 adult KTR, were included. Prophylaxis and preemptive therapy (PET) were predominant approaches among D+/R‐ and R + CMV serostatus transplants, respectively. Valganciclovir and ganciclovir were frequently utilized across CMV risk strata. Despite prevention approaches, approximately one‐fourth of KTR developed CMV infection. Age and D+/R‐ CMV serostatus were consistent risk factors for CMV infection/disease. CMV infection/disease was associated with increased mortality and graft loss. CMV was similarly associated with acute rejection (AR) risk, but with high heterogeneity among studies. Limited data were available on CMV and opportunistic infections (OIs) risk. CMV remains a significant issue. New strategies may be needed to optimize CMV management.
ISSN:1398-2273
1399-3062
DOI:10.1111/tid.13483