| Objectives Chronic hepatitis C virus (HCV) infection is the leading indication for liver transplantation (LT) worldwide. Although LT offers the optimal therapy for HCV-related end-stage liver disease and early-stage hepatoma, universal HCV reinfection of the graft is a major concern. The course of recurrent HCV infections after transplantation is accelerated, and recurrence results in graft cirrhosis in up to30%of recipients within5years. Long-term graft survival and patient survival are, therefore, impaired. Cyclosporine A (CSA), but not tacrolimus (TAC), inhibits hepatitis C virus (HCV) replication in vitro[19]. Clinical reports on the efficacy of interferon-a (IFNa)-based antiviral therapy (AVT) for recurrent HCV after liver transplantation (LT) with CSA and TAC are conflicting. The aim of the study was to assess whether AVT for recurrent HCV after LT is more effective with CSA or TAC.Methods Searching the literature in Pubmed, MEDLINE, EMbase, Science Citation Index, CBM, Wanfang Data, CNKI, VIP, Cochrane library, and the searching duration was set from the database establishing to Feb,2013. Chinese and English key words for searching include FK506or TAC or tacrolimus, Cyclosprin or Cyclosprin A or CSA, hepatitis C or hep C or HCV, LT or transplantation or transplant or graft, Interferon or IFN, pegylated-interferon or PEG-IFN, ribavirin or RBV. After screening the literature according to predefined standards, do the data analysis with professional RevMan4.2provided by Cochrane. Dichotomous data were expressed as relative risks (RRs) and95%confidence intervals (CIs) with a random effects model.Results In all,2764references were retrieved, and17observational studies met the eligibility criteria we defined and they are adopted into our meta-analysis this time. The pooled SVR rates were42%(395/945) with CSA and35%(471/1364) with TAC (RR=1.18,95%CI=1.00-1.39, P=0.05). Although the pooled data contained significant heterogeneity (12=45%, P=0.02), the SVR rates in the RCT were comparable (39%with CSA and35%with TAC). Limiting the analysis to the7studies reporting on40or more patients in each group (with1634patients in all) favored CSA (RR=1.23,95%CI=1.09-1.38, P<0.001), and heterogeneity disappeared (12=0%, P=0.62). Conclusions IFN-based AVT for recurrent HCV after LT seems marginally more effective with CSA versus TAC; the study heterogeneity, however, limits firm conclusions. |
