846 Is the Primary Immunosuppressive Drug (Cyclosporin a or Tacrolimus) Playing a Role on the Response to Antiviral Treatment for Post-Transplant HCV Recurrence?

Vero, Vittoria; Senzolo, Marco; Pasulo, L.; Ponziani, Francesca Romana; Viganò, R.; Marino, M.; Donato, Maria Francesca; Rendina, Maria; Toniutto, Pierluigi; Cescon, Matteo; Burra, P.; Miglioresi, L.; Paolo, D. Di; Giannelli, V.; Gasbarrini, Antonio; Fagiuoli, S.

doi:10.1016/s0016-5085(12)63623-3

Cited by 3 publications

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“…The κ agreement between the 2 reviewers was 0.843 ± 0.020 at this stage, which indicated very good interobserver agreement. After a detailed full‐text review of 225 references, 18 studies, including 14 full‐text articles and 4 abstracts, were included in the systematic review 4, 5, 7, 11, 12, 16‐28. The interobserver agreement at this stage was 1.00.…”

Section: Resultsmentioning

confidence: 99%

“…The studies were conducted primarily in Europe (n = 13),5, 7, 11, 12, 16, 17, 22‐28 with the remainder originating from North America (n = 4)4, 18‐20 and Japan (n = 1)21; all were published between 2006 and 2012. All but 1 study19 were uncontrolled with prospective (n = 6)5, 7, 16, 20, 23, 24 or retrospective designs (n = 11) 4, 11, 12, 17, 18, 21, 22, 25‐28. The study by Carrión et al17 was a randomized, open‐label, controlled study (AVT versus no treatment); however, we used data only from the treated study arm and, therefore, considered this an uncontrolled, prospective design for our analysis.…”

Section: Resultsmentioning

confidence: 99%

“…The study by Carrión et al17 was a randomized, open‐label, controlled study (AVT versus no treatment); however, we used data only from the treated study arm and, therefore, considered this an uncontrolled, prospective design for our analysis. All full‐text publications defined eligibility criteria and post‐LT AVT in detail, but they were less well described in the 4 abstracts 16, 20, 26, 28. In general, however, the diagnosis of recurrent HCV infections was uniform across all studies and consisted of a combination of detectable HCV RNA in serum (polymerase chain reaction), elevated serum transaminases, and evidence of histological changes in liver biopsy samples compatible with recurrent HCV infections.…”

Section: Resultsmentioning

confidence: 99%

“…Eleven studies, including the single RCT, reported on IFN‐based antiviral combination therapy using PEG‐IFN (α2a and/or α2b) and RBV exclusively,5, 7, 11, 16, 17, 19, 20, 22‐24, 27 whereas in 7 studies, standard IFN and PEG‐IFN were each used in a proportion of patients 4, 12, 18, 21, 25, 26, 28. All full‐text publications detailed a treatment schedule including changes in the doses of IFN and RBV (as tolerated by the participants).…”

Section: Resultsmentioning

confidence: 99%

“…Thirteen studies mentioned the use of erythropoietin and granulocyte colony‐stimulating factor in patients with anemia and leukopenia, respectively 4, 7, 11, 12, 16‐19, 22‐25, 27. The intended duration of therapy was 48 weeks regardless of the genotype (n = 8),4, 7, 17, 20, 25‐28 was 52 weeks (n = 1),16 or was dependent on virological responses (n = 2) 21, 23. Six studies planned 24 weeks of treatment for G2/G3 patients and 48 weeks for G1 patients 5, 12, 18, 19, 22, 24.…”

Section: Resultsmentioning

confidence: 99%

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Efficacy of antiviral therapy for hepatitis C after liver transplantation with cyclosporine and tacrolimus: A systematic review and meta-analysis

2012

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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

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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Efficacy of antiviral therapy for hepatitis C after liver transplantation with cyclosporine and tacrolimus: A systematic review and meta-analysis

2012

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Meeting report of the 2011 joint international congress of the international liver transplantation society, the European liver and intestine transplant association, and the liver intensive care group of Europe

Levitsky

Guckelberger

2012

Liver Transpl

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The International Liver Transplantation Society held its yearly meeting as a joint conference with the European Liver and Intestine Transplant Association and the Liver Intensive Care Group of Europe at the Valencia Congress Center (Valencia, Spain) from June 22 to 25, 2011. Nearly 1500 registrants attended the meeting, which opened with a premeeting conference entitled “Global Challenges and Controversies in Liver Transplantation.” This was followed by numerous oral and poster abstract sessions and topic sessions focused on medical, surgical, and intensive care aspects of liver transplantation (LT). This report summarizes key symposia and oral abstracts delivered at the meeting and is conveniently divided into subsections relevant to LT. It is not meant to be a critical or comprehensive evaluation of all the meeting presentations and is merely intended to highlight presentations and associated published literature dealing with key topics. Liver Transpl 18:282–289, 2012. © 2011 AASLD.

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Recurrent hepatitis C virus infection post liver transplantation: impact of choice of calcineurin inhibitor

Duvoux

Firpi

Grazi³

et al. 2013

Transpl Int

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Summary Recurrence of hepatitis C virus infection following liver transplantation (LT) for hepatitis C is universal. After LT, hepatitis C is associated with accelerated fibrosis progression and reduced graft and patient survival. Furthermore, responses to antiviral therapy in patients with recurrent hepatitis C virus post‐transplant are consistently sub‐optimal. Calcineurin inhibitors (CNIs) like cyclosporine A (CsA) and tacrolimus continue to dominate immunosuppressive regimens in this population; however, there is still uncertainty as to whether either offers an advantage in terms of patient outcomes. Although tacrolimus demonstrates improved efficacy in the general LT population, differences have begun to emerge between these agents regarding diabetogenic potential, antiviral activity, and fibrosis progression in patients with hepatitis C. This review critically evaluates the existing literature, providing an overview of the reported differences, concluding that despite conflicting evidence, a potential benefit of CsA in patients with hepatitis C is supported by the data and warrants further investigation. Future studies examining the role of CNIs in hepatitis C virus‐positive LT recipients are required to accurately examine the effects of CNIs on outcomes such as fibrosis progression, survival, and effects on response to antiviral therapy, to provide robust information that allows clinicians to make an informed choice concerning which CNI is best for their patients.

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846 Is the Primary Immunosuppressive Drug (Cyclosporin a or Tacrolimus) Playing a Role on the Response to Antiviral Treatment for Post-Transplant HCV Recurrence?

Cited by 3 publications

References 0 publications

Efficacy of antiviral therapy for hepatitis C after liver transplantation with cyclosporine and tacrolimus: A systematic review and meta-analysis

Efficacy of antiviral therapy for hepatitis C after liver transplantation with cyclosporine and tacrolimus: A systematic review and meta-analysis

Meeting report of the 2011 joint international congress of the international liver transplantation society, the European liver and intestine transplant association, and the liver intensive care group of Europe

Recurrent hepatitis C virus infection post liver transplantation: impact of choice of calcineurin inhibitor

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