Liao Haotian, Tan Ping, Zhu Zexin, Yan Xiaokai, Huang Jiwei
Department of Liver Surgery, Liver Transplantation Division, West China Hospital, Sichuan University, Chengdu 610041, China.
Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu 610041, China.
Clin Res Hepatol Gastroenterol. 2017 Jun;41(3):262-271. doi: 10.1016/j.clinre.2016.12.001. Epub 2017 Jan 9.
Studies focusing on the efficacy of SOF+DCV regimen on liver transplantation recipients with HCV infection are still limited. In the current study, we aimed to perform a systematic review and meta-analysis to evaluate the efficacy and tolerability of SOF+DCV regimen, with or without ribavirin, on post-LT setting.
A systematic literature search of various databases as well as abstracts of major liver diseases conferences was performed. Studies with SVR data in HCV infected liver transplantation recipients treated with daclatasvir/sofosbuvir regimen were included. All statistical analyses were conducted by R version 3.3.1 (The R Foundation for Statistical Computing, Vienna, Austria).
Seven studies with a total of 379 LT recipients were included in this study. Most of these LT recipients had genotype 1 HCV infection. The overall rate of SVR12 reached 93.3% (95% CI: 83.3% to 99.4%). After excluding the study of Fontana et al., the SVR12 reached 96.8% and heterogeneity was lowered down (P=0.17). In three studies, patients treated with SOF+DCV (n=146) had a higher SVR12 rate than that of patients treated with SOF+DCV+RBV (n=83) (OR 0.33, 95% CI: 0.12 to 0.87; P=0.02). There was no difference in SVR12 between patients infected with HCV genotype 1 and genotype 3 (P=0.57) and no difference was found in SVR12 rate between 12-week therapy and 24-week therapy (P=0.82). The most common adverse effects (AEs) were: anemia 32% (n=64/202), infections 26% (n=38/149), neutropenia 23% (n=35/149), thrombocytopenia 21% (n=32/149) and renal failure 8% (n=12/149).
SOF+DCV±RBV regimen is of high efficacy and tolerability in LT recipients with HCV infection.
关于索磷布韦（SOF）+达卡他韦（DCV）方案对丙型肝炎病毒（HCV）感染的肝移植受者疗效的研究仍然有限。在本研究中，我们旨在进行一项系统评价和荟萃分析，以评估SOF+DCV方案（含或不含利巴韦林）在肝移植后患者中的疗效和耐受性。
对各种数据库以及主要肝病会议的摘要进行了系统的文献检索。纳入了接受达卡他韦/索磷布韦方案治疗的HCV感染肝移植受者的持续病毒学应答（SVR）数据的研究。所有统计分析均使用R 3.3.1版本（奥地利维也纳的R统计计算基金会）进行。
本研究纳入了7项研究，共379例肝移植受者。这些肝移植受者大多感染了1型HCV。SVR12的总体发生率达到93.3%（95%置信区间：83.3%至99.4%）。排除Fontana等人的研究后，SVR12达到96.8%，异质性降低（P=0.17）。在三项研究中，接受SOF+DCV治疗的患者（n=146）的SVR12发生率高于接受SOF+DCV+RBV治疗的患者（n=83）（比值比0.33，95%置信区间：0.12至0.87；P=0.02）。HCV 1型和3型感染患者的SVR12无差异（P=0.57），12周治疗和24周治疗的SVR12发生率也无差异（P=0.82）。最常见的不良反应（AE）为：贫血32%（n=64/202）、感染26%（n=38/149）、中性粒细胞减少23%（n=35/149）、血小板减少21%（n=32/149）和肾衰竭8%（n=12/149）。
SOF+DCV±RBV方案在HCV感染的肝移植受者中具有较高的疗效和耐受性。
