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Interferon‐Based Combination Anti‐Viral Therapy for Hepatitis C Virus After Liver Transplantation: A Review and Quantitative Analysis
Author(s) -
Wang C. S.,
Ko H. H.,
Yoshida E. M.,
Marra C. A.,
Richardson K.
Publication year - 2006
Publication title -
american journal of transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.89
H-Index - 188
eISSN - 1600-6143
pISSN - 1600-6135
DOI - 10.1111/j.1600-6143.2006.01362.x
Subject(s) - medicine , ribavirin , pegylated interferon , liver transplantation , tolerability , hepatitis c , hepatitis c virus , transplantation , gastroenterology , combination therapy , discontinuation , immunology , virus , adverse effect
Recurrence of hepatitis C virus (HCV) infection after liver transplantation (LT) is universal. However, the efficacy, tolerability and safety of combination interferon and ribavirin (IFN–RIB) or peginterferon and ribavirin (PEG–RIB) anti‐viral therapies post‐LT are uncertain. We performed a comprehensive search of major medical databases (1980–2005) and conference proceedings (1996–2005). The main outcome measure was sustained virological response (SVR, undetectable HCV RNA) at 6 months. Summary estimates were calculated using random‐effects models. Twenty‐seven IFN–RIB and 21 PEG–RIB studies were included. IFN–RIB was associated with a pooled SVR rate of 24% (95% CI, 20–27%), while PEG–RIB was associated with an SVR rate of 27% (23–31%). Pooled discontinuation rates were 24% (21–27%) with IFN–RIB and 26% (20–32%) with PEG–RIB. The pooled rate of acute graft rejection was 2% (1–3%) with IFN–RIB and 5% (3–7%) with PEG–RIB. IFN–RIB and PEG–RIB therapies in HCV infection post‐LT were associated with similar but overall low SVR and were poorly tolerated. The rate of acute rejection was small. The therapeutic advantage of PEG–RIB therapy observed in non‐transplant chronic HCV infection appears to be attenuated post‐LT. Clinical trials are needed to evaluate reasons for this post‐transplant therapeutic disadvantage and to find strategies to ameliorate them.