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Meta-analysis: anti-viral therapy of hepatitis C virus-related liver disease in renal transplant patients Fabrizi F; Lunghi G; Dixit V; Martin PAliment Pharmacol Ther 2006[Nov]; 24 (10): 1413-22BACKGROUND: The efficacy and safety of interferon-based therapy in renal transplant recipients with hepatitis C remains unclear, although a number of small clinical trials have been published addressing this issue. AIM: To evaluate efficacy and safety of antiviral therapy with interferon (interferon alone or interferon plus ribavirin) in renal transplant patients with hepatitis C by performing a systematic review of the literature with a meta-analysis of clinical trials. METHODS: The primary outcomes were sustained virological response (as a measure of efficacy) and/or drop-out rate (as a measure of tolerability). We used the random-effects model of DerSimonian and Laird, with heterogeneity and sensitivity analysis. RESULTS: We identified 12 clinical trials (102 unique patients); there was one controlled study. The summary estimate for sustained virological response and drop-out rate was 18.0% (95% CI 7.0-29.0%) and 35.0% (95% CI 20-50%), respectively. The most frequent side-effect requiring interruption of treatment was graft dysfunction (n = 28; 71.7%). Meta-regression analysis showed an inverse and significant association between reference year and drop-out logit rate (P = 0.012); an inverse link between sustained virological response logit rate and frequency of hepatitis C virus genotype 1 (P = 0.067) and cirrhosis (P = 0.08) was found, even if no statistical significance was reached. No publication bias was observed. CONCLUSIONS: Interferon-based therapy of hepatitis C has poor tolerance and safety after renal transplant. The optimal treatment of hepatitis C after renal transplant requires additional agents or alternative therapeutic approaches.|Antiviral Agents/*adverse effects[MESH]|Hepatitis C, Chronic/*drug therapy[MESH]|Humans[MESH]|Interferons/*adverse effects[MESH]|Kidney Transplantation/*adverse effects[MESH]|Postoperative Complications/*drug therapy[MESH]|Ribavirin/*adverse effects[MESH]|Treatment Outcome[MESH] |
