Antiviral therapy for recurrent liver graft infection with hepatitis C virus.
BACKGROUND
Antiviral therapy to treat recurrent hepatitis C infection after liver transplantation is controversial.


OBJECTIVE
To compare the therapeutic efficacy and side effects of different antiviral regimens in patients with hepatitis C re-infected grafts after liver transplantation.


METHODS
We searched The Cochrane Hepato-Biliary Group Controlled Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL) in The Cochrane Library, MEDLINE, EMBASE, and Science Citation Index Expanded until September 2007.


METHODS
Only randomised clinical trials (irrespective of language, blinding, or publication status) comparing various antiviral therapies (alone or in combination) in the treatment of hepatitis C virus recurrence in liver transplantation were considered for the review.


METHODS
Two authors collected the data independently. We calculated the relative risk (RR) or weighted mean difference (WMD) with 95% confidence intervals (CI) using the fixed-effect and the random-effects models based on available case-analysis.


RESULTS
A total of 389 liver transplant recipients with proven hepatitis C recurrence were randomised in eleven trials to various interventions and controls. The mean proportion of genotype I was 77.8% in the seven trials that reported the genotype. Only one or two trials were included under each comparison. All the trials were of high risk of bias. There was no difference in the mortality, graft rejection, or in re-transplantation between intervention and control in any of the comparisons that reported these outcomes. None of the trials reported liver decompensation or quality of life. Life-threatening adverse effects were not reported in either group in any of the comparisons. Up to 87.5% of patients required reduction in dose and up to 42.9% of patients required cessation of treatment in the various comparisons because of adverse effects or because of patient's choice to stop treatment.


CONCLUSIONS
1. Considering the lack of clinical benefit and the frequent adverse effects, there is currently no evidence to recommend antiviral treatment for recurrent liver graft infection with HCV. 2. Further randomised clinical trials with adequate trial methodology and adequate duration of follow-up are necessary.
Gurusamy
Kurinchi Selvan
KS
University Department of Surgery, Royal Free Hospital and University College School of Medicine, 9th Floor, Royal Free Hospital, Pond Street, London, UK, NW3 2QG. kurinchi2k@hotmail.com
Osmani
Bujar
B
Xirouchakis
Elias
E
Burroughs
Andrew K
AK
Davidson
Brian R
BR
D000998:Antiviral Agents / Q000009:adverse effects / Q000627:therapeutic use*; D005838:Genotype; D006084:Graft Rejection / Q000453:epidemiology; D016174:Hepacivirus / Q000235:genetics; D006526:Hepatitis C / Q000188:drug therapy* / Q000401:mortality; D006801:Humans; D016031:Liver Transplantation / Q000009:adverse effects* / Q000401:mortality; D016032:Randomized Controlled Trials as Topic; D012008:Recurrence
D000998:Antiviral Agents