Table 2.

General characteristics of the studies included in the systematic literature review of post‐transplantation CMV‐EBV coinfection (N = 9)

Study	Study description	Subjects
SOT studies
Citation: Indolfi G, et al 2012 a , 13 Country/region: King's College Hospital, London, UK (single center)	Review of clinical notes of consecutive cases receiving liver transplants; case series; Apr 2007‐Feb 2008 Objective: To investigate the prevalence and timing of EBV and CMV infections during the first 21 d post transplantation in relation to graft function and acute cellular rejection in a large cohort of pediatric liver transplantation recipients treated in a single center	Sample size: 62 Inclusion criteria: NR Demographics: ‐Mean age: 56.7 (SD: 61.4) mo ‐Male: 53.2% (33/62)
Citation: Bamoulid J, et al 2013 8 Country/region: France (single center)	Patients undergoing renal transplantation; Jan 2002‐Dec 2010 Objective: To analyze the natural course of EBV infection in adult kidney transplant recipients, to define risk factors, and to assess the clinical consequences of EBV infection	Sample size: 383 Inclusion criteria: NR Demographics: ‐Mean age (SD) ▪No EBV viremia (n = 228): 48 (14.0) y ▪EBV viremia (n = 155): 49 (14.0) y
Citation: Bassil N, et al 2014 15 Country/region: France (single center)	Sub‐analysis of post‐renal transplant patients participating in the phase 3 BENEFIT and BENEFIT‐EXT RCT (belatacept vs CSA); Dec 2005‐May 2007 Objective: To compare the incidence of CMV, EBV, BKV, and JC virus (JCV) infections in de novo renal transplant patients receiving either belatacept‐ or CSA‐based immunosuppression	Sample size: 62 Inclusion criteria: ‐Patients with ≥ 3 y of follow‐up Demographics: ‐Mean age (SD): ▪Belatacept (n = 42): 48.4 (13.4) y ▪CSA (n = 20): 47.5 (15.0) y
Citation: Shivanesan P, et al 2016 17 Country/region: India (single center)	Longitudinal, observational cohort study of patients undergoing renal transplantation at a single center (duration of follow‐up: 6 mo) Objective: To assess the utility of qRT‐PCR as a diagnostic and monitoring tool for viral infections in post‐renal transplant patients	Sample size: 50 Inclusion criteria: NR Demographics: ‐Mean (SD) age: 35.1 (10.9) y ‐Male: 86% (43/50)
Citation: Barani R, et al 2018 14 Country/region: India (single center)	Patients who received renal transplants (1997‐2016) and were followed at a nephrology tertiary care center (2011‐2016) Objective: To detect EBV by real‑time qPCR in post‐renal transplant recipients and to analyze its co‐occurrence with CMV	Sample size: 89 Inclusion criteria: ‐Patients with symptoms suggestive of end‐organ disease, graft dysfunction, or mild elevation of renal parameters without symptoms ‐Excluded: SCID or asymptomatic with normal renal parameters Demographics: ‐Mean age ± SD (range): 39.2 ± 13.5 (11‐64) y
Citation: Blazquez‐Navarro A, et al 2018 16 Country/region: Germany (multicenter)	Sub‐analysis of patients undergoing renal transplantation as part of an RCT (basiliximab vs rabbit ATG; Harmony); Aug 2008‐Nov 2012 Objective: To assess the impact and relevance of BKV, CMV, and EBV reactivations during the first year post‐renal transplantation	Sample size: 540 Inclusion criteria: NR Demographics: ‐Median (IQR) age: 56 (45‐64) y ‐Male: 64.1% (346/540) ‐Median (IQR) BMI: 25.8 (23.2‐29.0) kg/m2
HSCT studies
Citation: Zallio F, et al 2013 a , 20 Country/region: Italy (single center)	Patients with advanced hematologic malignancies and allogeneic HSCT; Mar 2005‐Dec 2011 Objective: To establish the role of molecular monitoring and preemptive treatment with rituximab post‐HSCT; to investigate the potential association between CMV reactivation and the development of EBV reactivation with respect to including CMV as a risk factor for PTLD	Sample size: 101 Inclusion criteria: NR Demographics: ‐Median (range) age: 50 (20‐70) y ‐Male: 54.5% (55/101)
Citation: Garcia‐Cadenas I, et al 2015 19 Country/region: Barcelona, Spain (Hospitals Sant Pau and Vall d’Hebrón in Barcelona)	Adult patients undergoing allo‐SCT; Sep 2006‐May 2013 Objective: To compare the incidence and prognosis of EBV‐related complications between patients with baseline high‐risk characteristics for PTLD and those with refractory GVHD, prospectively monitored for EBV DNAemia with early rituximab as preemptive therapy	Sample size: 133 Inclusion criteria: ‐At high risk for EBV complications, or ‐Was not at high risk for EBV disease at baseline but developed moderate‐to‐severe acute SR‐GVHD Demographics: ‐Median (range) age: ▪High risk for EBV (n = 93): 41 (18‐67) y ▪SR‐GVHD (n = 40): 53 (21‐68) y ‐Male, %: ▪High risk for EBV (n = 93): 63.4% (59/93) ▪SR‐GVHD (n = 40): 62.5% (25/40)
Citation: Fan J, et al 2016 18 Country/region: China (single center)	Follow‐up study of patients who received HSCT; Jan‐Jun 2012 Objective: To assess the relationships between CMV, EBV, and HHV‐6 infections after HSCT and to identify potential risk factors for viral infection	Sample size: 44 Inclusion criteria: ‐IgG‐positive/IgM‐negative CMV Demographics: ‐Median (range) age: 26 (16‐55) y ‐Male: 52.3% (23/44)

Abbreviations: ATG, anti‐thymocyte globulin; BKV, BK virus; BMI, body mass index; CMV, cytomegalovirus; CSA, cyclosporine A; d, days; EBV, Epstein‐Barr virus; GVHD, graft‐vs‐host disease; HHV‐6, human herpesvirus 6; HSCT, hematopoietic stem cell transplantation; Ig, immunoglobulin; IQR, interquartile range; mo, month; NR, not reported; PTLD, post‐transplant lymphoproliferative disease; qPCR, quantitative polymerase chain reaction; qRT‐PCR, quantitative reverse transcription‐polymerase chain reaction; RCT, randomized controlled trial; SCID, severe combined immunodeficiency disease; SCT, stem cell transplantation; SD, standard deviation; SOT, solid organ transplant; SR‐GVHD, steroid‐refractory graft‐vs‐host disease; y, years.

^aRetrospective analysis.