STUDIES EVALUATING HIGH-DOSE ACYCLOVIR, INTRAVENOUS IMMUNE GLOBULIN, AND CYTOMEGALOVIRUS HYPERIMMUNOGLOBULIN FOR PROPHYLAXIS AGAINST CYTOMEGALOVIRUS IN KIDNEY-TRANSPLANT RECIPIENTS

OBJECTIVE: To describe the epidemiology and pathogenesis of cytomegalo virus (CMV) and critically analyze the studies evaluating the cost, sa fety, and efficacy of high-dose acyclovir, intravenous immune globulin (IVIG), and CMV hyperimmunoglobulin (CMVIG) for prophylaxis against C MV in kidney transplant recipients. DATA SOURCES: Appropriate articles were identified by searching MEDLINE, Various combinations of the fol lowing medical subject heading terms were used: immunoglobulins, intra venous acyclovir; CMVIG; CMV infections; kidney transplantation: IVIG; and prophylaxis. STUDY SELECTION: Studies evaluating or discussing th e cost, safety, and efficacy of IVIG, high-dose acyclovir, and CMVIG i n kidney transplant recipients were included. DATA EXTRACTION: The dat a were evaluated with respect to study design, patient population, pro phylactic regimen, incidence of CMV complications, investigators' defi nitions of terminology, and cost analysis. The studies are summarized in cables and discussed in the test. DATA SYNTHESIS: The definitions o f terminology used by; the investigators varied widely among studies. The studies were reviewed and discussed using the following definition s: CMV infection was the presence of CMV antibodies in a previously CM V-seronegative patient or a fourfold rise in antibody titer after tran splantation; CMV syndrome was CMV infection plus unexplained fever, le ukopenia, or thrombocytopenia in the absence of an identifiable cause: and CMV disease was CMV syndrome plus pneumonitis, enteritis, retinit is, hepatitis. or central nervous system involvement. CONCLUSIONS: All regimens appear to effectively reduce the incidence of CMV-associated complications compared with placebo. Due to the lack of trials compar ing cost, efficacy, and safety, the most effective prophylactic treatm ent is unknown.