title: Tacrolimus-based versus cyclosporine-based immunosuppression in hepatitis C virus-infected patients after liver transplantation: a meta-analysis and systematic review.
abstract: BACKGROUND
  Most 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.
  
  
  METHODS
  Related 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.
  
  
  RESULTS
  Nine 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.
  
  
  CONCLUSIONS
  These 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.
authors.affiliation: Department of Periodontology and Oral Medicine, College of Stomatology, Guangxi Medical University, Nanning, Guangxi, China.
authors.forename: Zhenmin
authors.initials: Z
authors.lastname: Liu
authors.affiliation: Department of Periodontology and Oral Medicine, College of Stomatology, Guangxi Medical University, Nanning, Guangxi, China.
authors.forename: Yi
authors.initials: Y
authors.lastname: Chen
authors.affiliation: Department of Periodontology and Oral Medicine, College of Stomatology, Guangxi Medical University, Nanning, Guangxi, China.
authors.forename: Renchuan
authors.initials: R
authors.lastname: Tao
authors.affiliation: Department of Hepato-biliary Surgery, First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China.
authors.forename: Jing
authors.initials: J
authors.lastname: Xv
authors.affiliation: Department of Hepato-biliary Surgery, First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China.
authors.forename: Jianyuan
authors.initials: J
authors.lastname: Meng
authors.affiliation: Department of Periodontology and Oral Medicine, College of Stomatology, Guangxi Medical University, Nanning, Guangxi, China.
authors.forename: Xiangzhi
authors.initials: X
authors.lastname: Yong
mesh_terms: D016572:Cyclosporine / Q000627:therapeutic use*; D006084:Graft Rejection / Q000188:drug therapy* / Q000209:etiology / Q000401:mortality; D006085:Graft Survival / Q000187:drug effects; D016174:Hepacivirus / Q000302:isolation & purification*; D006526:Hepatitis C / Q000601:surgery* / Q000821:virology; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D016031:Liver Transplantation / Q000009:adverse effects*; D012008:Recurrence; D015996:Survival Rate; D016559:Tacrolimus / Q000627:therapeutic use*
chemical_list: D007166:Immunosuppressive Agents; D016572:Cyclosporine; D016559:Tacrolimus