GCV/VCVG prophylaxis against CMV DNAemia in pediatric renal transplant patients: A systematic review and meta-analysis.Chatani, B., Glaberson, W. et al. (2019).
Pediatric Transplantation; [record in progress].
The study had three specific aims: evaluating the length of ganciclovir/valganciclovir (GCV/VGCV) prophylaxis as correlated to the prevention of cytomegalovirus (CMV) DNAemia; comparing the incidence of leukopenia among differing lengths of GCV/VGCV prophylaxis; and assessing the optimal length of prophylaxis for preventing CMV DNAemia in high-risk patients.
The PubMed, EMBASE, ISI Web of Science database engines, and Cochrane Central Register were serarched in this systematic review (Inclusion criteria required that studies used GCV/VGCV for prophylaxis of CMV, involved renal transplantation, commented on pediatric data, and commented on incidence of CMV DNAemia. Exclusion criteria removed studies which were duplicates, single case reports, or review articles without original data.)
6 studies were included, which focussed on pediatric renal transplantation and the analysis of VCGV/GCV for the prevention of CMV DNAemia.
Outcomes that were assessed included CMV DNAemia incidence associated with length of GCV/VGCV prophylaxis and incidence of leukopenia by length of prophylaxis.
This is a well-written report of a good quality systematic review. A variety of databases were searched for evidence, and with a comprehensive search strategy. Studies were screened by two reviewers, and studies were evaluated in duplicate using the STROBE checklist. Six studies were included in the subsequent meta-analysis, two were multicentre and four were single centre. All were cohort studies. There is a good amount of information regarding differences and similarities between the included studies. Statistical tests for heterogeneity were conducted (Cochrane Q and I-squared). In the high risk group this study found no significant difference in viraemia risk between the different durations of prophylaxis (<6m, 6-12 and >12m). This may be due to the watering down of numbers to get the risk stratification and affecting the power of the meta-analysis. There was also no significant difference seen in the risk of leukopenia between the different durations of prophylaxis. This meta-analysis is limited by the amount and quality of available study data on CMV prophylaxis in paediatric transplant recipients. The meta-analysis is strongly influenced by the single largest included study, Hocker et al, in which a smaller proportion of patients received induction immune suppression compared to the other included studies.
Systematic review - quality assessment not necessary.