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Antiviral prophylaxis is commonly used in recipients of solid-organ transplants with the aim of preventing the clinical syndrome associated with cytomegalovirus infection. We undertook a systematic review to investigate whether this approach affects risks of cytomegalovirus disease and death.

Randomised controlled trials of prophylaxis with antiviral medications for cytomegalovirus disease in solid-organ-transplant recipients were identified. Data were combined in meta-analyses by a random-effects model.

Compared with placebo or no treatment, prophylaxis with aciclovir, ganciclovir, or valaciclovir significantly reduced the risks of cytomegalovirus disease (19 trials, 1981 patients; relative risk 0·42 [95% CI 0·34–0·52]), cytomegalovirus infection (17 trials, 1786 patients; 0·61 [0·48–0·77]), and all-cause mortality (17 trials, 1838 patients; 0·63 [0·43–0·92]), mainly owing to lower mortality …