The Role of Antiviral Prophylaxis for the Prevention of Epstein-Barr Virus-Associated Posttransplant Lymphoproliferative Disease in Solid Organ Transplant Recipients: A Systematic Review

Am J Transplant. 2017 Mar;17(3):770-781. doi: 10.1111/ajt.14020. Epub 2016 Oct 3.


The role of antiviral prophylaxis for the prevention of posttransplant lymphoproliferative disease (PTLD) remains controversial for solid organ transplantation (SOT) recipients who are seronegative for Epstein-Barr virus (EBV) but who received organs from seropositive donors. We performed a systematic review and meta-analysis to address this issue. Two independent assessors extracted data from studies after determining patient eligibility and completing quality assessments. Overall, 31 studies were identified and included in the quantitative synthesis. Nine studies were included in the direct comparisons (total 2366 participants), and 22 were included in the indirect analysis. There was no significant difference in the rate of EBV-associated PTLD in SOT recipients among those who received prophylaxis (acyclovir, valacyclovir, ganciclovir, valganciclovir) compared with those who did not receive prophylaxis (nine studies; risk ratio 0.95, 95% confidence interval 0.58-1.54). No significant differences were noted across all types of organ transplants, age groups, or antiviral use as prophylaxis or preemptive therapy. There was no significant heterogeneity in the effect of antiviral prophylaxis on the incidence of PTLD. In conclusion, the use of antiviral prophylaxis in high-risk EBV-naive patients has no effect on the incidence of PTLD in SOT recipients.

Keywords: antibiotic prophylaxis; antibiotic: antiviral-ganciclovir/valganciclovir; clinical research/practice; infection and infectious agents; infectious disease; meta-analysis; pharmacology; posttransplant lymphoproliferative disorder (PTLD); viral: Epstein-Barr Virus (EBV).

Publication types

  • Meta-Analysis
  • Review
  • Systematic Review

MeSH terms

  • Antiviral Agents / therapeutic use*
  • Epstein-Barr Virus Infections / complications*
  • Epstein-Barr Virus Infections / virology
  • Herpesvirus 4, Human / pathogenicity*
  • Humans
  • Lymphoproliferative Disorders / etiology
  • Lymphoproliferative Disorders / prevention & control*
  • Organ Transplantation / methods*
  • Premedication / methods*
  • Prognosis


  • Antiviral Agents