Purpose: To summarise the epidemiology, clinical outcomes, and treatment patterns of cytomegalovirus (CMV) infection among organ transplant recipients in China.
Methods: Searches were conducted in seven electronic databases from 2013 to March 2023. Observational and interventional studies with standard of care among organ transplant recipients in China that reported incidence of CMV infection, incidence of recurrent CMV infection and CMV diseases among patients with CMV infection, treatment patterns, and treatment-limiting toxicities were included. All analyses were performed using R 4.1.1 software with random-effects model.
Results: A total of 28 studies with 9213 patients were included (Figure 1).

The pooled incidence of CMV infection from 22 studies was 22.51% (95% confidence interval (CI) 16.14% - 28.89%) (Figure 2).

Specifically, the pooled incidence of CMV infection after liver transplantation was 23.62% (95% CI 14.72% - 32.53%) based on 11 studies. For kidney transplantation recipients, the pooled incidence was 13.01% (95% CI 8.18% - 17.83%) based on 10 studies. Two studies reported CMV infection rates among thoracic organ transplant recipients, which was 61.24% and 52.27%, respectively. The CMV breakthrough infection rate during prophylaxis was 15.28% (95% CI 7.37% - 23.20%) based on 3 studies.   
Among the patients with CMV infection, the pooled incidence of recurrent CMV infection was 15.16% (95% CI 5.75 – 24.57%) based on 4 studies. The incidence of CMV disease from 11 studies was 46.22% (95% CI 35.22% - 57.42%). CMV pneumonitis had a pooled incidence of 23.21% (95% CI: 12.67%-33.76%), which was the most commonly reported CMV disease.
Seventeen studies provided information about prophylaxis therapy, and 4 studies provided information about pre-emptive therapy. Ganciclovir and valganciclovir were the most commonly used drugs in both therapeutic approaches. Among recipients treated with ganciclovir or valganciclovir, the most frequently reported adverse event was myelosuppression, with incidence rates ranging from 31% to 77% and 10% to 24%, respectively.
Conclusion: In China, CMV infection is a common viral infection that may occur after solid organ transplantation. The risk of infection may vary depending on the type of transplant. Despite taking prophylaxis therapy, breakthrough infections remain a concern. Currently, ganciclovir and valganciclovir are the main treatment options. However, they carry a high risk of myelosuppression. Findings highlight the unmet need for a more effective treatment without treatment-limiting toxicities.