Influence of Calcineurin Inhibitors Selection On the Outcome of HCV Recurrence in Liver Transplantation Recipients: A Meta-Analysis.

Abstract

Background and Objective A controversy exists over whether the selection of calcineurin inhibitors (CNIs), namely Tacrolimus (Tac) or Cyclosporine A (CsA), can influence the outcomes of liver transplant recipients with hepatitis C virus (HCV) infection, especially the outcome of HCV recurrence. Here, we performed a meta-analysis on the outcomes of HCV infected liver transplant recipients treated with Tac or CsA. Methods We performed an electronic database search as well as a manual search of relevant journals until the end of 2012. The selection criteria were randomized controlled trials (RCT) with Tac and CsA treatment arms in which HCV-infected liver transplant recipients were included in the study population. Two authors identified and extracted data independently. Dichotomous data were expressed as relative risks (RR) and 95% confidence intervals (CI). Results In all, eight RCTs with 734 patients were included in this study. No significant heterogeneity was detected among the pooled data (all P values > 0.1) and a fixed effects model was used to calculate the overall treatment effect size. Statistically significant differences between Tac and CsA groups were not found for the incidences of severe fibrosis (RR = 0.98, 95% CI = 0.59-1.62, P = 0.93), fibrosing cholestatic hepatitis (RR = 0.98, 95% CI 0.49-1.95, P = 0.95), patient mortality (RR = 0.70, 95% CI 0.49-1.01, P = 0.06) and graft survival (RR = 0.88, 95% CI 0.64-1.23, P = 0.46). Regarding the aspect of rejection, Tac group exhibited a lower incidence of acute rejection than CsA group (RR = 0.68, 95% CI 0.49-0.95, P = 0.02).Figure: No Caption available.Figure: No Caption available.Conclusion: CNIs selection did not influence the outcome of liver transplant recipients with HCV infection. However, Tac can offer advantages over CsA in lowering the incidence of acute rejection.