The Role of Antiviral Prophylaxis for the Prevention of Epstein-Barr Virus (EBV) Associated Post-Transplant Lymphoproliferative Disease (PTLD) in Solid Organ Transplant Recipients: A Systematic Review
1Medicine, Division of Infectious Diseases, University Health Network, Toronto, On, Canada
2Pediatrics, Division of Infectious Diseases, King Abdulaziz Medical City, National Guard Health Affairs, Jeddah, Saudi Arabia
3Multi-Organ Transplant Unit, University Health Network, Toronto, ON, Canada.
Meeting: 2015 American Transplant Congress
Abstract number: D267
Keywords: Epstein-Barr virus (EBV), Post-transplant lymphoproliferative disorder (PTLD), Prophylaxis, Viral therapy
Session Information
Session Name: Poster Session D: Viral Infections
Session Type: Poster Session
Date: Tuesday, May 5, 2015
Session Time: 5:30pm-6:30pm
Presentation Time: 5:30pm-6:30pm
Location: Exhibit Hall E
Background
The role of antiviral prophylaxis in EBV seronegative solid organ transplant recipients receiving organs from seropositive donors for prevention of PTLD remains controversial. We performed a systemic review and metanalysis to answer this question.
Methods
We searched Ovid MEDLINE (from 1960 to May 2014) and the Cochrane Central Registry of Controlled Trials (CENTRAL) in The Cochrane Library without any language or age restrictions. Two independent reviewers assessed the selected studies for eligibility, quality assessment, and extracted data. Results were reported as Risk Ratio (RR) with 95% confidence intervals (CI) for dichotomous outcomes. Statistical analyses were performed using the random-effects model.
Results
Thirty-one studies were identified and included in the quantitative synthesis. Ten studies were included in the direct comparisons (total 2385 subjects) while 21, including 2 RCTs, were included in the indirect analysis.
There was no significant difference in the rate of EBV associated PTLD in SOT recipients among those who received prophylaxis (acyclovir, valaciclovir, gancyclovir or valgancyclovir) compared to those who did not receive prophylaxis (10 studies; RR 0.95, 95% CI 0.58, to 1.54). Subgroup analysis by the type of antiviral agent used also revealed nosignificant difference in the rate of PTLD when using CMV active agents (4 studies; RR 0.63, 95% CI 0.17 to 2.37) or HSV active agents (4 studies; RR 0.92, 95% CI 0.42 to 2.04). This effect failed to reach significance in both adults (2 studies; RR 0.43, 95% CI 0.03 to 6.27) and children (6 studies; RR 0.82; 95% CI 0.44 to 1.52). No significant differences were noted across all types of organ transplants or use of antivirals as pre-emptive therapy or prophylaxis. There was no significant heterogeneity in the effect of antiviral prophylaxis on the incidence of PTLD.
Conclusions
The use of antiviral prophylaxis in the high-risk EBV naive patients had no effect on the incidence of PTLD in SOT recipients. These findings were consistent across the different antiviral agents, age groups, and type of organ transplant.
To cite this abstract in AMA style:
AlDabbagh M, Gitman M, Kumar D, Humar A, Rotstein C, Husain S. The Role of Antiviral Prophylaxis for the Prevention of Epstein-Barr Virus (EBV) Associated Post-Transplant Lymphoproliferative Disease (PTLD) in Solid Organ Transplant Recipients: A Systematic Review [abstract]. Am J Transplant. 2015; 15 (suppl 3). https://atcmeetingabstracts.com/abstract/the-role-of-antiviral-prophylaxis-for-the-prevention-of-epstein-barr-virus-ebv-associated-post-transplant-lymphoproliferative-disease-ptld-in-solid-organ-transplant-recipients-a-systematic-review/. Accessed November 21, 2024.« Back to 2015 American Transplant Congress