Westerouen van Meeteren M J, Hayee B, Inderson A, van der Meulen A E, Altwegg R, van Hoek B, Pageaux G P, Stijnen T, Stein D, Maljaars P W J
Leiden University Medical Centre, Department of Gastroenterology-Hepatology, Leiden, The Netherlands.
King's College Hospital, Department of Gastroenterology, London, UK.
J Crohns Colitis. 2017 Sep 1;11(9):1146-1151. doi: 10.1093/ecco-jcc/jjx057.
Little is known about the risk of serious infection when combining anti-tumour necrosis factor [TNF] therapy for refractory inflammatory bowel disease [IBD] with immunosuppression after liver transplantation [LT]. Our aim was to investigate the infection risk in this patient group by systematic review and meta-analysis of the available data.
A search was conducted for full papers and conference proceedings through September 2015, regarding liver transplant recipients and anti-TNF therapy. All studies were appraised using the adapted Newcastle-Ottawa Scale [NOS]. Two reviewers independently extracted patient data [age, duration of follow-up, number of all infections, number of serious infections, time since transplant]. As an additional control population, primary sclerosing cholangitis [PSC]-IBD patients from the Leiden University Medical Center [LUMC] LT cohort were used. Poisson regression was used to compare serious infections (according to International Conference on Harmonisation [ICH] definition) per patien-year follow-up between the anti-TNF and control groups.
In all 465 articles and abstracts were identified, of which eight were included. These contained 53 post-LT patients on anti-TNF therapy and 23 post-LT patients not exposed to anti-TNF therapy. From the LUMC LT-cohort, 41 PSC patients with PSC-IBD not exposed to anti-TNF therapy were included as control population. The infection rate for TNF-exposed patients was 0.168 serious infections per patient year, compared with 0.149 in the control patients (rate ratio 1.12 [95% confidence interval: 0.233-5.404, P = 0.886]. When correcting for time since transplant, the infection rate was 0.194 in the TNF-exposed vs 0.115 in the non-exposed [p = 0.219].
No significant increase in the rate of serious infection was observed in LT recipients with PSC-IBD during exposure to anti-TNF therapy.
对于难治性炎症性肠病（IBD）的抗肿瘤坏死因子（TNF）治疗与肝移植（LT）后免疫抑制联合应用时发生严重感染的风险，人们了解甚少。我们的目的是通过对现有数据进行系统评价和荟萃分析，来调查该患者群体的感染风险。
检索截至2015年9月有关肝移植受者和抗TNF治疗的全文论文及会议论文集。所有研究均使用改编的纽卡斯尔-渥太华量表（NOS）进行评估。两名研究者独立提取患者数据（年龄、随访时间、所有感染的数量、严重感染的数量、移植后的时间）。作为额外的对照人群，使用了来自莱顿大学医学中心（LUMC）肝移植队列的原发性硬化性胆管炎（PSC）-IBD患者。采用泊松回归比较抗TNF组和对照组每患者年随访期间的严重感染（根据国际协调会议[ICH]定义）情况。
共识别出465篇文章和摘要，其中8篇被纳入。这些研究包含53例接受抗TNF治疗的肝移植后患者和23例未接受抗TNF治疗的肝移植后患者。从LUMC肝移植队列中，纳入41例未接受抗TNF治疗的PSC-IBD患者作为对照人群。接受TNF治疗患者的感染率为每患者年0.168例严重感染，而对照患者为0.149例（率比1.12[95%置信区间：0.233 - 5.404，P = 0.886]）。校正移植后的时间后，接受TNF治疗患者的感染率为0.194，未接受治疗患者为0.115（P = 0.219）。
在PSC-IBD的肝移植受者接受抗TNF治疗期间，未观察到严重感染率显著增加。
