Efficacy and safety of valganciclovir 900 mg versus 450 mg for cytomegalovirus prophylaxis in transplantation: direct Meta-analysis using recent data.

초록

Introduction: Valgancivlovir is impotantly used to prevent post-transplant CMV infection among kidney transplantation patients. However, the dose of such drug being used still remains controversial since the continuous use of such drug decrease kidney functions and induces leukopenia in some of the cases. Accordingly, the purpose is to measure the appropriate dose of the drug required for preventing CMV. Method: A systematic review and meta-analysis using a randome-effects model was performed. We searched the Cochrane Central Register, OVID MEDLINE, EMBASE, and Pubmed until april 15, 2017. We reviewe the reference lists of relevant reviews, registered trials, and relevant conference proceedings. Definition of low dose valganciclovir group is 450mg and standard dose one is 900mg. Result: Four trials were included, consisting of a total of 725 patients In the pooled analysis. As a result of analyzing the two groups, Upon completion of the research, the GFR value, graft loss, tacrolimus level, AMR, TCMR, fungal and candida infection indicated no difference between the two groups. However CMV incidence showed tendency to decrease in the low dose group 0.584 (0.352-0.967) P=0.036, 0.427 (0.274-0.667) P=0.001. The biopsy proven rejection decreased by 0.427 times in the low dose group in comparison to the standard group (0.274-0.667) P =0.002, and the leukopenia event decreased by 0.402 times in the low dose group in comparison to the standard group (0.273 ? 0.592) P =0.001 as well. Conclusion: The dose of valganciclovir used to prevent the post-transplant CMV infection was adjusted to 450mg. As a result, such dose was effective in preventing CMV viremia and the side effects such as leukopenia caused by the drug also decreased. In the future, the dose of valgancivlovir being used should be adjusted to 450mg in order to prevent the CMV infection as well as to enhance the economic effects.