Liu Jiaye, Ma Buyun, Cao Wanlu, Li Meng, Bramer Wichor M, Peppelenbosch Maikel P, Pan Qiuwei
Biomedical Research Center, Northwest Minzu University, Lanzhou, China.
Erasmus MC Cancer Institute, Erasmus MC-University Medical Center, Rotterdam, The Netherlands.
Transpl Infect Dis. 2019 Apr;21(2):e13047. doi: 10.1111/tid.13047. Epub 2019 Jan 21.
Comprehensive evaluation of safety and efficacy of different combinations of direct-acting antivirals (DAAs) in liver transplant recipients with genotype 1 (GT1) hepatitis C virus (HCV) recurrence remains limited. Therefore, we performed this systematic review and meta-analysis in order to evaluate the clinical outcome of DAA treatment in liver transplant patients with HCV GT1 recurrence.
Studies were included if they contained information of 12 weeks sustained virologic response (SVR12) after DAA treatment completion as well as treatment related complications for liver transplant recipients with GT1 HCV recurrence.
We identified 16 studies comprising 885 patients. The overall pooled estimate proportion of SVR12 was 93% (95% confidence interval (CI): 0.89, 0.96), with moderate heterogeneity observed (τ = 0.01, P < 0.01, I =75%). High tolerability was observed in liver transplant recipients reflected by serious adverse events (sAEs) with pooled estimate proportion of 4% (95% CI: 0.01, 0.07; τ = 0.02, P < 0.01, I = 81%). For subgroup analysis, a total of five different DAA regimens were applied for treating these patients. Sofosbuvir/Ledipasvir (SOF/LDV) led the highest pooled estimate SVR12 proportion, followed by Paritaprevir/Ritonavir/Ombitasivir/Dasabuvir (PrOD), Daclatasvir (DCV)/Simeprevir (SMV) ± Ribavirin (RBV), and SOF/SMV ± RBV, Asunaprevir (ASV)/DCV. There was a tendency for favoring a higher pooled SVR12 proportion in patients with METAVIR Stage F0-F2 of 97% (95% CI: 0.93, 0.99) compared to 85% (95% CI: 0.79, 0.90) for stage F3-F4 (P < 0.01). There was no significant difference between LT recipients treated with or without RBV (P = 0.23).
Direct-acting antiviral treatment is highly effective and well-tolerated in liver transplant recipients with recurrent GT1 HCV infection.
对于基因型1（GT1）丙型肝炎病毒（HCV）复发的肝移植受者，不同直接抗病毒药物（DAA）组合的安全性和有效性的综合评估仍然有限。因此，我们进行了这项系统评价和荟萃分析，以评估DAA治疗GT1 HCV复发肝移植患者的临床结局。
纳入的研究需包含DAA治疗完成后12周持续病毒学应答（SVR12）的信息以及GT1 HCV复发肝移植受者的治疗相关并发症。
我们确定了16项研究，共885例患者。SVR12的总体合并估计比例为93%（95%置信区间（CI）：0.89，0.96），观察到中度异质性（τ = 0.01，P < 0.01，I = 75%）。肝移植受者的耐受性较高，严重不良事件（sAE）的合并估计比例为4%（95% CI：0.01，0.07；τ = 0.02，P < 0.01，I = 81%）。亚组分析中，共应用了五种不同的DAA方案治疗这些患者。索磷布韦/维帕他韦（SOF/LDV）的合并估计SVR12比例最高，其次是帕罗韦德/利托那韦/奥比他韦/达沙布韦（PrOD）、达克拉他韦（DCV）/西米普明（SMV）±利巴韦林（RBV）以及SOF/SMV±RBV、阿舒瑞韦（ASV）/DCV。METAVIR分期为F0 - F2的患者的合并SVR12比例倾向于更高，为97%（95% CI：0.93，0.99），而F3 - F4期为85%（95% CI：0.79，0.90）（P < 0.01）。接受或未接受RBV治疗的肝移植受者之间无显著差异（P = 0.23）。
直接抗病毒治疗在复发GT1 HCV感染的肝移植受者中高效且耐受性良好。
