TY - JOUR
T1 - Does post-transplant cytomegalovirus increase the risk of invasive aspergillosis in solid organ transplant recipients? A systematic review and meta-analysis
AU - Chuleerarux, Nipat
AU - Thongkam, Achitpol
AU - Manothummetha, Kasama
AU - Nematollahi, Saman
AU - Dioverti-Prono, Veronica
AU - Torvorapanit, Pattama
AU - Langsiri, Nattapong
AU - Worasilchai, Navaporn
AU - Plongla, Rongpong
AU - Chindamporn, Ariya
AU - Sanguankeo, Anawin
AU - Permpalung, Nitipong
N1 - Funding Information:
Acknowledgments: This publication was made possible by support from the Sherrilyn and Ken Fisher Center for Environmental Infectious Diseases, Division of Infectious Diseases of the Johns Hopkins University School of Medicine. Its contents are solely the responsibility of the authors and do not necessarily represent the official view of the Fisher Center or Johns Hopkins University School of Medicine. We would like to extend our gratitude to librarians at Chulalongkorn University and Johns Hopkins University School of Medicine for their contribution in retrieving full papers of studies that were not available on the databases.
Funding Information:
Conflicts of Interest: Nematollahi reported receiving a grant from the Fisher Center Discovery Program, Johns Hopkins University. Worasilchai, Plongla, and Chindamporn reported receiving grants from the Health Systems Research Institute (Thailand) and Rachadapiseksompotch Fund, Chulalongkorn University, outside the submitted work. Permpalung reported receiving grants and salary support from the Health Systems Research Institute (Thailand), the Fisher Center Discovery Program, Johns Hopkins University, the Cystic Fibrosis Foundation, and Cidara outside the submitted work. Permpalung has served on the Advisory Board for Shionogi Inc. No other conflict of interest to declare.
Funding Information:
This publication was made possible by support from the Sherrilyn and Ken Fisher Center for Environmental Infectious Diseases, Division of Infectious Diseases of the Johns Hopkins University School of Medicine. Its contents are solely the responsibility of the authors and do not necessarily represent the official view of the Fisher Center or Johns Hopkins University School of Medicine. We would like to extend our gratitude to librarians at Chulalongkorn University and Johns Hopkins University School of Medicine for their contribution in retrieving full papers of studies that were not available on the databases.
Publisher Copyright:
© 2021 by the authors. Licensee MDPI, Basel, Switzerland.
PY - 2021
Y1 - 2021
N2 - Background: Cytomegalovirus (CMV) and invasive aspergillosis (IA) cause high morbid-ity and mortality in solid organ transplant (SOT) recipients. There are conflicting data with respect to the impact of CMV on IA development in SOT recipients. Methods: A literature search was con-ducted from existence through to 2 April 2021 using MEDLINE, Embase, and ISI Web of Science databases. This review contained observational studies including cross-sectional, prospective co-hort, retrospective cohort, and case-control studies that reported SOT recipients with post-trans-plant CMV (exposure) and without post-transplant CMV (non-exposure) who developed or did not develop subsequent IA. A random-effects model was used to calculate the pooled effect estimate. Results: A total of 16 studies were included for systematic review and meta-analysis. There were 5437 SOT patients included in the study, with 449 SOT recipients developing post-transplant IA. Post-transplant CMV significantly increased the risk of subsequent IA with pORs of 3.31 (2.34, 4.69), I2 = 30%. Subgroup analyses showed that CMV increased the risk of IA development regardless of the study period (before and after 2003), types of organ transplantation (intra-thoracic and intra-abdominal transplantation), and timing after transplant (early vs. late IA development). Further analyses by CMV definitions showed CMV disease/syndrome increased the risk of IA development, but asymptomatic CMV viremia/infection did not increase the risk of IA. Conclusions: Post-trans-plant CMV, particularly CMV disease/syndrome, significantly increased the risks of IA, which high-lights the importance of CMV prevention strategies in SOT recipients. Further studies are needed to understand the impact of programmatic fungal surveillance or antifungal prophylaxis to prevent this fungal-after-viral phenomenon.
AB - Background: Cytomegalovirus (CMV) and invasive aspergillosis (IA) cause high morbid-ity and mortality in solid organ transplant (SOT) recipients. There are conflicting data with respect to the impact of CMV on IA development in SOT recipients. Methods: A literature search was con-ducted from existence through to 2 April 2021 using MEDLINE, Embase, and ISI Web of Science databases. This review contained observational studies including cross-sectional, prospective co-hort, retrospective cohort, and case-control studies that reported SOT recipients with post-trans-plant CMV (exposure) and without post-transplant CMV (non-exposure) who developed or did not develop subsequent IA. A random-effects model was used to calculate the pooled effect estimate. Results: A total of 16 studies were included for systematic review and meta-analysis. There were 5437 SOT patients included in the study, with 449 SOT recipients developing post-transplant IA. Post-transplant CMV significantly increased the risk of subsequent IA with pORs of 3.31 (2.34, 4.69), I2 = 30%. Subgroup analyses showed that CMV increased the risk of IA development regardless of the study period (before and after 2003), types of organ transplantation (intra-thoracic and intra-abdominal transplantation), and timing after transplant (early vs. late IA development). Further analyses by CMV definitions showed CMV disease/syndrome increased the risk of IA development, but asymptomatic CMV viremia/infection did not increase the risk of IA. Conclusions: Post-trans-plant CMV, particularly CMV disease/syndrome, significantly increased the risks of IA, which high-lights the importance of CMV prevention strategies in SOT recipients. Further studies are needed to understand the impact of programmatic fungal surveillance or antifungal prophylaxis to prevent this fungal-after-viral phenomenon.
KW - Aspergillosis
KW - CMV
KW - Cytomegalovirus
KW - Fungal infection
KW - Transplantation
UR - http://www.scopus.com/inward/record.url?scp=85105332156&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85105332156&partnerID=8YFLogxK
U2 - 10.3390/jof7050327
DO - 10.3390/jof7050327
M3 - Review article
C2 - 33922773
AN - SCOPUS:85105332156
SN - 2309-608X
VL - 7
JO - Journal of Fungi
JF - Journal of Fungi
IS - 5
M1 - 327
ER -