Valacyclovir versus valganciclovir for cytomegalovirus prophylaxis in kidney transplant recipients: a systematic review and comparative meta-analysis
- Author:
Leonardo Januário Campos CARDOSO
1
;
Kleuber Arias Meireles MARTINS
;
Paulo Vitor MARQUES
;
Ivan Petterson Santana TEIXEIRA
;
Ester MAGALHÃES
;
Juan Lima MINKAUSKAS
;
Isabela Coutinho FARIA
;
Filipe Melo RIBEIRO
Author Information
- Publication Type:Original Article
- From: Clinical Transplantation and Research 2025;39(1):24-35
- CountryRepublic of Korea
- Language:English
-
Abstract:
Background:Valganciclovir (ValG) is the most widely used drug for cytomegalovirus (CMV) prophylaxis in kidney transplant recipients (KTRs). However, it is associated with dose-limiting side effects and considerable costs. Some centers have identified valacyclovir (ValA) as an economically attractive alternative with a lower risk of bone marrow suppression. The comparative effectiveness of these two drugs is not well-established.This study aims to compare the efficacy and safety of ValA and ValG for CMV prophylaxis in KTRs.
Methods:Searches were conducted of the Medline, Cochrane, Web of Science, Embase, and Ovid databases. Endpoints encompassed the incidence of CMV disease, CMV viremia, acute rejection, leukopeniaeutropenia, and other infections, including BK polyomavirus and non-CMV herpesviruses (HVs). Risk ratios (RRs) with 95% confidence intervals (CIs) were pooled using a random-effects model.
Results:Six studies, comprising 888 patients (438 receiving ValA), were included. The groups were comparable in CMV viremia incidence (RR, 0.70; 95% CI, 0.31–1.57; P=0.4) and the development of CMV disease (RR, 0.74; 95% CI, 0.09–5.97; P=0.8). No significant differences in acute rejection rates were observed (RR, 0.97; 95% CI, 0.50–1.91;P=0.8). However, the rate of leukopeniaeutropenia was significantly lower in the ValA group (RR, 0.57; 95% CI, 0.42–0.77; P<0.01). No significant differences were noted for BK viremia (RR, 0.67; 95% CI, 0.24–1.87; P=0.4) or other HV infections (RR, 1.43; 95% CI, 0.61–3.38; P=0.4).
Conclusions:The drugs demonstrate comparable efficacy in preventing CMV infection following kidney transplantation. However, ValA may have a lower impact on bone marrow suppression.
