Meta‐analysis: anti‐viral therapy of hepatitis C virus‐related liver disease in renal transplant patients

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Abstract
Summary Background 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.