Effect of spleen operation on antiviral treatment in hepatitis C virus-related cirrhotic patients.
OBJECTIVE
To investigate the impact of spleen operation (SO) on interferon-α (IFN-α)-based antiviral treatment in patients with hepatitis C virus (HCV)-related cirrhosis.


METHODS
Studies were systematically identified by searching electronic databases including MEDLINE, Cochrane Library, Elsevier, and Embase up to September 30, 2013, and relevant clinical studies were reviewed. Sustained virological response (SVR) rate and adherence to therapy were taken as the endpoints of interest.


RESULTS
A total of 603 patients from 16 studies were included in the systematic review. Of 372 patients who underwent SO followed by antiviral treatment, the total SVR rate was 39.5%. SVR was associated with HCV genotypes 2/3 (OR = 10.84; 95%CI: 5.47-21.47; P < 0.00001). IFN-α dose needed to be reduced in 29.4%, and IFN-α-based therapy was discontinued in 11.5% of patients. Analysis of controlled studies showed that SVRs were achieved in 34.1% of patients with SO and 31.1% of patients without SO. SO had no effect on the SVR rate in cirrhotic patients with genotype 1 HCV infection (OR = 1.28; 95%CI: 0.51-3.22; P = 0.60), but improved the SVR rate in patients with genotypes 2/3 infection, though the difference was not significant (OR = 0.36; 95%CI: 0.13-1.02; P = 0.05).


CONCLUSIONS
SO combined with IFN-α-based antiviral therapy may be suitable in cirrhotic patients with genotypes 2/3 HCV infection, but not in those with genotype 1 infection.
Bo Feng, Wei Zhang, Bi-Fen Luo, Guang-Jun Song, Jian Wang, Qian Jin, Hong Qin, Lai Wei, Peking University People's Hospital, Peking University Hepatology Institute, Beijing Key Laboratory of Hepatitis C and Immunotherapy for Liver Diseases, Beijing 100044, China.
Bo
B
Feng
Bo Feng, Wei Zhang, Bi-Fen Luo, Guang-Jun Song, Jian Wang, Qian Jin, Hong Qin, Lai Wei, Peking University People's Hospital, Peking University Hepatology Institute, Beijing Key Laboratory of Hepatitis C and Immunotherapy for Liver Diseases, Beijing 100044, China.
Wei
W
Zhang
Bo Feng, Wei Zhang, Bi-Fen Luo, Guang-Jun Song, Jian Wang, Qian Jin, Hong Qin, Lai Wei, Peking University People's Hospital, Peking University Hepatology Institute, Beijing Key Laboratory of Hepatitis C and Immunotherapy for Liver Diseases, Beijing 100044, China.
Bi-Fen
BF
Luo
Bo Feng, Wei Zhang, Bi-Fen Luo, Guang-Jun Song, Jian Wang, Qian Jin, Hong Qin, Lai Wei, Peking University People's Hospital, Peking University Hepatology Institute, Beijing Key Laboratory of Hepatitis C and Immunotherapy for Liver Diseases, Beijing 100044, China.
Guang-Jun
GJ
Song
Bo Feng, Wei Zhang, Bi-Fen Luo, Guang-Jun Song, Jian Wang, Qian Jin, Hong Qin, Lai Wei, Peking University People's Hospital, Peking University Hepatology Institute, Beijing Key Laboratory of Hepatitis C and Immunotherapy for Liver Diseases, Beijing 100044, China.
Jian
J
Wang
Bo Feng, Wei Zhang, Bi-Fen Luo, Guang-Jun Song, Jian Wang, Qian Jin, Hong Qin, Lai Wei, Peking University People's Hospital, Peking University Hepatology Institute, Beijing Key Laboratory of Hepatitis C and Immunotherapy for Liver Diseases, Beijing 100044, China.
Qian
Q
Jin
Bo Feng, Wei Zhang, Bi-Fen Luo, Guang-Jun Song, Jian Wang, Qian Jin, Hong Qin, Lai Wei, Peking University People's Hospital, Peking University Hepatology Institute, Beijing Key Laboratory of Hepatitis C and Immunotherapy for Liver Diseases, Beijing 100044, China.
Hong
H
Qin
Bo Feng, Wei Zhang, Bi-Fen Luo, Guang-Jun Song, Jian Wang, Qian Jin, Hong Qin, Lai Wei, Peking University People's Hospital, Peking University Hepatology Institute, Beijing Key Laboratory of Hepatitis C and Immunotherapy for Liver Diseases, Beijing 100044, China.
Lai
L
Wei
D000998:Antiviral Agents / Q000009:adverse effects / Q000627:therapeutic use*; D016009:Chi-Square Distribution; D004621:Embolization, Therapeutic / Q000009:adverse effects / Q000379:methods*; D005838:Genotype; D016174:Hepacivirus / Q000187:drug effects / Q000235:genetics; D006526:Hepatitis C / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy*; D006801:Humans; D000077190:Interferon alpha-2; D016898:Interferon-alpha / Q000009:adverse effects / Q000627:therapeutic use*; D008103:Liver Cirrhosis / Q000175:diagnosis / Q000601:surgery* / Q000821:virology; D055118:Medication Adherence; D016017:Odds Ratio; D018579:Patient Selection; D011092:Polyethylene Glycols / Q000009:adverse effects / Q000627:therapeutic use*; D011994:Recombinant Proteins / Q000009:adverse effects / Q000627:therapeutic use; D012307:Risk Factors; D013156:Splenectomy / Q000009:adverse effects; D013157:Splenic Artery; D013997:Time Factors; D016896:Treatment Outcome; D019562:Viral Load
D000998:Antiviral Agents; D000077190:Interferon alpha-2; D016898:Interferon-alpha; D011994:Recombinant Proteins; D011092:Polyethylene Glycols; C417083:peginterferon alfa-2b; C100416:peginterferon alfa-2a
Hepatitis C virus cirrhosis; Interferon, Ribavirin; Partial splenic embolization; Splenectomy