Introduction: Organ transplant recipients face a substantial risk of developing posttransplant lymphoproliferative disorder (PTLD). In over 90% of cases involving B‐cell PTLD following solid organ transplantation, the Epstein‐Barr virus (EBV) genome is promptly identified, usually within the initial year. A continuing discussion revolves around the efficacy of antiviral prophylaxis in mitigating the incidence of PTLD in solid organ transplant patients. We conducted a systematic review and meta-analysis to investigate this matter.
Method: A comprehensive search was conducted up to July 31, 2023, in databases including PubMed, Embase, and the Cochrane Library for retrospective and prospective studies comparing antiviral prophylaxis effects on EVB viremia, EBV disease, and PTLD incidence in solid organ transplant recipients.
Results: In total, 26 eligible studies involving 13,245 patients were analyzed. The rate of PTLD in SOT recipients was significantly lower among those who received antiviral prophylaxis compared to those who did not, as reported in 18 studies (risk ratio 0.76, 95% CI 0.62 to 0.92). Additionally, a notable reduction was seen in the pediatric subgroup (RR 0.55, 95% CI 0.42 to 0.73), but no significant differences were observed in the subgroup of high-risk recipients based on EBV serology (RR 1.04, 95% CI 0.69 to 1.55).  Analyzing the impact of antiviral prophylaxis on reducing EBV viremia incidence revealed a significant decrease in 10 studies (risk ratio 0.65, 95% CI 0.49 to 0.87); however, no significant decrease in the incidence of EBV disease was evident in the 5 studies reviewed (risk ratio 1.31, 95% CI 0.87 to 1.98).
Conclusion: This study suggests that administering antiviral prophylaxis to patients after solid organ transplantation reduces PTLD and EBV viremia occurrences.