Interferon-Based Combination Anti-Viral Therapy for Hepatitis C Virus After Liver Transplantation: A Review and Quantitative Analysis

Authors

  • C. S. Wang,

    1. Department of Medicine and Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, British Columbia, Canada
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  • H. H. Ko,

    1. Department of Medicine and Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, British Columbia, Canada
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  • E. M. Yoshida,

    Corresponding author
    1. Department of Medicine and Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, British Columbia, Canada
    2. The British Columbia Transplant Society, Vancouver, British Columbia, Canada
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  • C. A. Marra,

    1. Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada
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  • K. Richardson

    1. Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada
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* Corresponding author: Eric M. Yoshida, eyoshida@interchange.ubc.ca

Abstract

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.

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