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Review
. 2014 Sep 14;20(34):12330-40.
doi: 10.3748/wjg.v20.i34.12330.

Efficacy of immunosuppression monotherapy after liver transplantation: a meta-analysis

Xiang Lan  1 , Meng-Gang Liu  1 , Hong-Xu Chen  1 , Hong-Ming Liu  1 , Wei Zeng  1 , Dong Wei  1 , Ping Chen  1
Affiliations
Review

Efficacy of immunosuppression monotherapy after liver transplantation: a meta-analysis

Xiang Lan et al. World J Gastroenterol. .

Abstract

Aim: To assess the advantages and disadvantages of immunosuppression monotherapy after transplantation and the impact of monotherapy on hepatitis C virus (HCV) recurrence.

Methods: Articles from Cochrane Hepato-Biliary Group Controlled Trials Register, the Cochrane Central Register of Controlled Trials in The Cochrane Library, MEDLINE, EMBASE, and Science Citation Index Expanded, including non-English literature identified in these databases, were searched up to January 2013. We included randomized clinical trials comparing various immunosuppression monotherapy and prednisone-based immunosuppression combinations for liver transplantation. The modified Jadad scale score or the Oxford quality scoring system was used. Meta-analyses were performed with weighted random-effects models.

Results: A total of 14 randomized articles including 1814 patients were identified. Eight trials including 1214 patients compared tacrolimus monotherapy (n = 610) vs tacrolimus plus steroids or triple therapy regarding acute rejection and adverse events (n = 604). Five trials, including 285 patients, compared tacrolimus monotherapy (n = 143) vs tacrolimus plus steroids or triple therapy regarding hepatitis C recurrence (n = 142). Four trials including 273 patients compared cyclosporine monotherapy (n = 148) vs cyclosporine and steroids regarding acute rejection and adverse events (n = 125). Two trials including 170 patients compared mycophenolate mofetil monotherapy (n = 86) vs combinations regarding acute rejection (n = 84). There were no significant differences in the acute rejection rates between tacrolimus monotherapy (RR = 1.04, P = 0.620), and cyclosporine monotherapy (RR = 0.89, P = 0.770). Mycophenolate mofetil monotherapy had a significant increase in the acute rejection rate (RR = 4.50, P = 0.027). Tacrolimus monotherapy had no significant effects on the recurrence of hepatitis C (RR = 1.03, P = 0.752). More cytomegalovirus infection (RR = 0.48, P = 0.000) and drug-related diabetes mellitus (RR = 0.54, P = 0.000) were observed in the immunosuppression combination therapy groups.

Conclusion: Tacrolimus and cyclosporine monotherapy may be as effective as immunosuppression combination therapy. Mycophenolate mofetil monotherapy was not considerable. Tacrolimus monotherapy does not increase recurrence of HCV.

Keywords: Cytomegalovirus; Diabetes; Immunosuppression monotherapy; Liver transplantation; Meta-analysis.

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Figures

Figure 1
Figure 1
Selection of studies.
Figure 2
Figure 2
Meta-analysis of randomized cohort studies comparing the effect of tacrolimus monotherapy on graft acute rejection. Heterogeneity was tested and was found to be not statistically significant (χ2 = 8.58, P = 0.284).
Figure 3
Figure 3
Meta-analysis of andomized cohort studies comparing the effect of tacrolimus monotherapy. A: Drug-related hypertension. Heterogeneity was tested and was found to be not statistically significant (χ2 = 4.21, P = 0.240); B: Cytomegalovirus infection. Heterogeneity was tested and was found to be not statistically significant (χ2 = 1.44, P = 0.696). C: Drug-related diabetes mellitus. Heterogeneity was tested and was found to be not statistically significant (χ2 = 8.10, P = 0.088).
Figure 4
Figure 4
Meta-analysis of andomized cohort studies comparing the effect of tacrolimus monotherapy on hepatitis C virus recurrence. Heterogeneity was tested and was not statistically significant (χ2 = 8.63, P = 0.071).
Figure 5
Figure 5
Meta-analysis of randomized cohort studies comparing the effect of cyclosporine monotherapy. A: Graft rejection. Heterogeneity was tested and was found to be not statistically significant (χ2 = 1.72, P = 0.632); B: Drug-related diabetes mellitus. Heterogeneity was tested and was found to be not statistically significant (χ2 = 1.72, P = 0.697).
Figure 6
Figure 6
Meta-analysis of randomized cohort studies comparing the effect of mycophenolate mofetil monotherapy on acute rejection. Heterogeneity was tested and was found to be not statistically significant (χ2 = 0.13, P = 0.77).
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