Minor increases in serum creatinine are clinically relevant and can adversely affect survival. Every effort should be made to avoid precipitation of AKI in cirrhosis and ascites.

Diastolic dysfunction, indicated by reduced E/A ratio, is prevalent in advanced cirrhosis and is associated with reduced ascites clearance and increased mortality post TIPS, possibly related to worsening of hemodynamic dysfunction in the post-TIPS period.

Cyclosporine A (CSA), but not tacrolimus (TAC), inhibits hepatitis C virus (HCV) replication in vitro. 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. 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)(1996)(1997)(1998)(1999)(2000)(2001)(2002)(2003)(2004)(2005)(2006)(2007)(2008)(2009)(2010)(2011)(2012) and a manual abstract search (2005)(2006)(2007)(2008)(2009)(2010)(2011)(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 ¼ 1.18, 95% CI ¼ 1.00-1.39, P ¼ 0.05). Although the pooled data contained significant heterogeneity (I 2 ¼ 45%, P ¼ 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 ¼ 1.23, 95% CI ¼ 1.09-1.38, P < 0.001), and heterogeneity disappeared (I 2 ¼ 0%, P ¼ 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. V C 2012 AASLD.Received April 1, 2012; accepted July 10, 2012.Chronic hepatitis C virus (HCV) infection is the leading indication for liver transplantation (LT) worldwide. 1,2 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 to 30% of