Impact of Calcineurin Inhibitors on Hepatitis C Recurrence After Liver Transplantation

Kim, Robin D.; Mizuno, Shugo; Sorensen, Jeffrey; Schwartz, Jason J.; Fujita, Shiro

doi:10.1007/s10620-011-1871-z

Cited by 15 publications

(11 citation statements)

References 13 publications

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“…A retrospective study was established in patients who underwent liver transplantation for hepatitis C virus-induced liver disease to evaluate the impact of calcineurin inhibitors, and the cyclosporine group showed improved histological hepatitis C virus recurrence-free survival compared to the tacrolimus group (55.4% vs. 30.8% at 1 year, 18.6% vs. 10.3% at 3 years, 16.7% vs. 8.1% at 5 years, p<0.001) [20]. As for the risk factors associated with survival and histological HCV recurrence, donor age and gender combined with tacrolimus use were taken into account in previous studies [20]–[23]. Donor age was reported in only four included trials [17], [24]–[26].…”

Section: Discussionmentioning

confidence: 99%

Tacrolimus-Based versus Cyclosporine-Based Immunosuppression in Hepatitis C Virus-Infected Patients after Liver Transplantation: A Meta-Analysis and Systematic Review

et al. 2014

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BackgroundMost liver transplant recipients receive calcineurin inhibitors (CNIs), especially tacrolimus and cyclosporine, as immunosuppressant agents to prevent rejection. A controversy exists as to whether the outcomes of hepatitis C virus (HCV)-infected liver transplant patients differ based on the CNIs used. This meta-analysis compares the clinical outcomes of tacrolimus-based and cyclosporine-based immunosuppression, especially cases of HCV recurrence in liver transplant patients with end-stage liver disease caused by HCV infection.MethodsRelated articles were identified from the Cochrane Hepato-Biliary Group Controlled Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL) in the Cochrane Library, Medline, and Embase. Meta-analyses were performed for the results of homogeneous studies.ResultsNine randomized or quasi-randomized controlled trials were included. The total effect size of mortality (RR = 0.98, 95% CI: 0.77–1.25, P = 0.87) and graft loss (RR = 1.05, 95% CI: 0.83–1.33, P = 0.67) showed no significant difference between the two groups irrespective of duration of immunosuppressant therapy after liver transplantation. In addition, the HCV recurrence-induced mortality (RR = 1.11, 95% CI: 0.66–1.89, P = 0.69), graft loss (RR = 1.62, 95% CI: 0.64–4.07, P = 0.31) and retransplantation (RR = 1.40, 95% CI: 0.48–4.09, P = 0.54), as well as available biopsies, confirmed that histological HCV recurrences (RR = 0.92, 95% CI: 0.71–1.19, P = 0.51) were similar.ConclusionThese results suggested no difference in posttransplant HCV recurrence-induced mortality, graft loss and retransplantation, as well as histological HCV recurrence in patients treated with tacrolimus-based and cyclosporine-based immunosuppresion.

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Section: Discussionmentioning

confidence: 99%

Tacrolimus-Based versus Cyclosporine-Based Immunosuppression in Hepatitis C Virus-Infected Patients after Liver Transplantation: A Meta-Analysis and Systematic Review

et al. 2014

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“…Several studies with small populations have confirmed this in vivo series [26, 120–123]. Recently, Spanish groups performing a multicenter retrospective analysis reported that the use of cyclosporine-based immunosuppression regimens and longer treatment duration may protect patients against viral relapse after antiviral treatment [124].…”

Section: Immunosuppression and Recurrent Hepatitis Cmentioning

confidence: 57%

Liver Transplantation and Hepatitis C

Akamatsu

Sugawara

2012

International Journal of Hepatology

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Hepatitis-C-virus- (HCV-) related end-stage cirrhosis is the primary indication for liver transplantation in many countries. Unfortunately, however, HCV is not eliminated by transplantation and graft reinfection is universal, resulting in fibrosis, cirrhosis, and finally graft decompensation. The use of poor quality organs, particularly from older donors, has a highly negative impact on the severity of recurrence and patient/graft survival. Although immunosuppressive regimens have a considerable impact on the outcome, the optimal regimen after liver transplantation for HCV-infected patients remains unclear. Disease progression monitoring with protocol biopsy and new noninvasive methods is essential for predicting patient/graft outcome and starting antiviral treatment with the appropriate timing. Antiviral treatment with pegylated interferon and ribavirin is currently considered the most promising regimen with a sustained viral response rate of around 30% to 35%, although the survival benefit of this regimen remains to be investigated. Living-donor liver transplantation is now widely accepted as an established treatment for HCV cirrhosis and the results are equivalent to those of deceased donor liver transplantation.

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“…Shift of tacrolimus to cyclosporine occurs in patients who experience tacrolimus related side effects. Recently, Kim et al [40] compared recipients of LDLT who received cyclosporine and tacrolimus as immunosuppressive agents. Their results indicated that graft and patient survival rates were similar in the 2 groups, but histologic HCV-recurrence-free survival was significantly higher in the cyclosporine group.…”

Section: Discussionmentioning

confidence: 99%

Predictors of Disease Recurrence Post Living Donor Liver Transplantation in End Stage Chronic HCV Patients

et al. 2014

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HCV recurrence represents a universal phenomenon after liver transplantation. In this study Fifty HCV patients who underwent living donor liver transplantation were enrolled and factors that may accelerate HCV reinfection of the allograft such as donor's age and degree of liver steatosis, recipient's age, gender, BMI, MELD score, liver functions, HCV viral load, type of immunosuppressive drug, and genetic polymorphisms of IL28B, OAS, and IL1B were studied. The results of disease-free survival (DFS) rates showed inverse correlation with the recipient's postoperative levels of ALT, AST, ALP (P < 0.001, <0.001, and 0.006 resp.) as well as pre- and postoperative titers of HCV RNA (P < 0.003 and <0.001 resp.). Recipient's IL28B SNP was a significant factor in predicting postoperative DFS (P < 0.025). However, SNPs in OAS and IL1B genes had no apparent correlation with DFS. Cox proportional hazards model revealed that patients with elevated levels of ALT, preoperative viral titers, IL28B CT, and IL28B TT were 8.28, 4.22, 3.35, and 1.36 times, respectively, more likely to develop recurrence. In conclusion IL28B SNP, ALT level, and preoperative HCV titer besides proper choice of immunosuppressant are helpful for predicting posttransplant HCV recurrence and DFS.

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Impact of Calcineurin Inhibitors on Hepatitis C Recurrence After Liver Transplantation

Abstract: Patients transplanted for hepatitis C virus and treated with cyclosporine versus tacrolimus may have a higher recurrence-free survival.

Cited by 15 publications

References 13 publications

Tacrolimus-Based versus Cyclosporine-Based Immunosuppression in Hepatitis C Virus-Infected Patients after Liver Transplantation: A Meta-Analysis and Systematic Review

Tacrolimus-Based versus Cyclosporine-Based Immunosuppression in Hepatitis C Virus-Infected Patients after Liver Transplantation: A Meta-Analysis and Systematic Review

Liver Transplantation and Hepatitis C

Predictors of Disease Recurrence Post Living Donor Liver Transplantation in End Stage Chronic HCV Patients

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