Interferon-based anti-viral therapy for hepatitis C virus infection after renal transplantation: an updated meta-analysis

PLoS One. 2014 Apr 3;9(4):e90611. doi: 10.1371/journal.pone.0090611. eCollection 2014.

Abstract

Background: Hepatitis C virus (HCV) infection is highly prevalent in renal transplant (RT) recipients. Currently, interferon-based (IFN-based) antiviral therapies are the standard approach to control HCV infection. In a post-transplantation setting, however, IFN-based therapies appear to have limited efficacy and their use remains controversial. The present study aimed to evaluate the efficacy and safety of IFN-based therapies for HCV infection post RT.

Methods: We searched Pubmed, Embase, Web of Knowledge, and The Cochrane Library (1997-2013) for clinical trials in which transplant patients were given Interferon (IFN), pegylated interferon (PEG), interferon plus ribavirin (IFN-RIB), or pegylated interferon plus ribavirin (PEG-RIB). The Sustained Virological Response (SVR) and/or drop-out rates were the primary outcomes. Summary estimates were calculated using the random-effects model of DerSimonian and Laird, with heterogeneity and sensitivity analysis.

Results: We identified 12 clinical trials (140 patients in total). The summary estimate for SVR rate, drop-out rate and graft rejection rate was 26.6% (95%CI, 15.0-38.1%), 21.1% (95% CI, 10.9-31.2%) and 4% (95%CI: 0.8%-7.1%), respectively. The overall SVR rate in PEG-based and standard IFN-based therapy was 40.6% (24/59) and 20.9% (17/81), respectively. The most frequent side-effect requiring discontinuation of treatment was graft dysfunction (14 cases, 45.1%). Meta-regression analysis showed the covariates included contribute to the heterogeneity in the SVR logit rate, but not in the drop-out logit rate. The sensitivity analyses by the random model yielded very similar results to the fixed-effects model.

Conclusions: IFN-based therapy for HCV infection post RT has poor efficacy and limited safety. PEG-based therapy is a more effective approach for treating HCV infection post-RT than standard IFN-based therapy. Future research is required to develop novel strategies to improve therapeutic efficacy and tolerability, and reduce the liver-related morbidity and mortality in this important patient population.

Publication types

  • Meta-Analysis
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Antiviral Agents / therapeutic use*
  • Clinical Trials as Topic
  • Hepacivirus / drug effects*
  • Hepatitis C / drug therapy*
  • Hepatitis C / etiology
  • Humans
  • Interferons / therapeutic use*
  • Kidney Diseases / complications*
  • Kidney Diseases / surgery
  • Kidney Transplantation / adverse effects*
  • Postoperative Complications / drug therapy*
  • Postoperative Complications / etiology
  • Treatment Outcome

Substances

  • Antiviral Agents
  • Interferons

Grants and funding

This research was supported by the National Natural Science Foundation of China (81171560, 30930082, 81171561, 30972584), The National Science and Technology Major Project of China (2008ZX10002-006, 2012ZX1002007001, 2011ZX09302005, 2012ZX09303001-001, 2012ZX10002003), The National High Technology Research and Development Program of China (2011AA020111), the Key Project of Chongqing Science and Technology Commission (cstc2012gg-yyjsB10007), the Chongqing Natural Science Foundation (cstc2011jjA10025), and the Medical Research Fund by Chongqing Municipal Health Bureau (2009-1-71). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.