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Efficacy of antiviral therapy for hepatitis C after liver transplantation with cyclosporine and tacrolimus: A systematic review and meta‐analysis
Author(s) -
Rabie Rania,
Mumtaz Khalid,
Renner Eberhard L.
Publication year - 2013
Publication title -
liver transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.814
H-Index - 150
eISSN - 1527-6473
pISSN - 1527-6465
DOI - 10.1002/lt.23516
Subject(s) - medicine , ribavirin , liver transplantation , tacrolimus , meta analysis , randomized controlled trial , hepatitis c , pegylated interferon , hepatitis c virus , relative risk , transplantation , confidence interval , combination therapy , gastroenterology , immunology , virus
Cyclosporine A (CSA), but not tacrolimus (TAC), inhibits hepatitis C virus (HCV) replication in vitro. Clinical reports on the efficacy of interferon‐α (IFNα)–based antiviral therapy (AVT) for recurrent HCV after liver transplantation (LT) with CSA and TAC are conflicting. Our aim was to assess whether AVT for recurrent HCV after LT is more effective with CSA or TAC. We performed an electronic database search (1995‐2012) and a manual abstract search (2005‐2012). The a priori defined eligibility criteria included the use of AVT for recurrent HCV with IFN (standard or pegylated) and ribavirin and the reporting of sustained virological response (SVR) rates with CSA and TAC (the primary outcome). Two authors identified and extracted data independently. Dichotomous data were expressed as relative risks (RRs) and 95% confidence intervals (CIs) with a random effects model. In all, 5058 references were retrieved, and 1 randomized controlled trial (RCT) and 17 observational studies (13 full‐text articles) met the eligibility criteria; the meta‐analysis was based on the latter studies. The pooled SVR rates were 42% (395/945) with CSA and 35% (471/1364) with TAC (RR = 1.18, 95% CI = 1.00‐1.39, P = 0.05). Although the pooled data contained significant heterogeneity ( I 2 = 45%, P = 0.02), the SVR rates in the RCT were comparable (39% with CSA and 35% with TAC). Limiting the analysis to the 7 studies reporting on 40 or more patients in each group (with 1634 patients in all) favored CSA (RR = 1.23, 95% CI = 1.09‐1.38, P < 0.001), and heterogeneity disappeared ( I 2 = 0%, P = 0.62). In conclusion, IFN‐based AVT for recurrent HCV after LT seems marginally more effective with CSA versus TAC; the study heterogeneity, however, limits firm conclusions. Liver Transpl 19:36–48, 2013. © 2012 AASLD.