Tacrolimus-based versus cyclosporine-based immunosuppression in hepatitis C virus-infected patients after liver transplantation: a meta-analysis and systematic review.
Tacrolimus-based versus cyclosporine-based immunosuppression in hepatitis C virus-infected patients after liver transplantation: a meta-analysis and systematic review.
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肝移植后丙型肝炎病毒感染患者基于他克莫司与基于环孢素的免疫抑制：荟萃分析和系统评价
DOI：
10.1371/journal.pone.0107057
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发表时间：
2014
期刊：
影响因子：
3.7
通讯作者：
Yong X
中科院分区：
文献类型：
--
作者：
Liu Z;Chen Y;Tao R;Xv J;Meng J;Yong X
背景大多数肝移植受者接受钙调神经磷酸酶抑制剂（CNIs），特别是他克莫司和环孢素，作为免疫抑制剂，以防止排斥反应。关于丙型肝炎病毒（HCV）感染的肝移植患者的结局是否因CNI的使用而异存在争议。本荟萃分析比较了他克莫司和环孢素为基础的免疫抑制剂的临床结局，特别是HCV感染引起的终末期肝病肝移植患者的HCV复发病例。方法检索科克伦肝胆组对照试验数据库、科克伦图书馆的科克伦对照试验中心数据库、Medline和Embase。对同质性研究的结果进行荟萃分析。结果纳入9个随机或半随机对照试验。死亡率（RR = 0.98，95%CI：0.77-1.25，P = 0.87）和移植物丢失（RR = 1.05，95%CI：0.83-1.33，P = 0.67）的总效应量显示，无论肝移植术后免疫抑制剂治疗的持续时间如何，两组之间均无显著差异。 此外，HCV复发诱导的死亡率（RR = 1.11，95% CI：0.66-1.89，P = 0.69）、移植物丢失（RR = 1.62，95% CI：0.64-4.07，P = 0.31）和再次移植（RR = 1.40，95% CI：0.48-4.09，P = 0.54）以及可用的活检证实组织学HCV复发（RR = 0.92，95% CI：0.71-1.19，P = 0.51）相似。 结论以他克莫司为基础的免疫抑制剂与以环孢素为基础的免疫抑制剂在移植后HCV复发导致的死亡率、移植物丢失和再次移植以及组织学HCV复发方面无差异。
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. Conclusion 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.
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4.6
作者：
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