Effect of spleen operation on antiviral treatment in hepatitis C virus-related cirrhotic patients

Abstract

Aim: To investigate the impact of spleen operation (SO) on interferon-α (IFN-α)-based antiviral treatment in patients with hepatitis C virus (HCV)-related cirrhosis.

Methods: Studies were systematically identified by searching electronic databases including MEDLINE, Cochrane Library, Elsevier, and Embase up to September 30, 2013, and relevant clinical studies were reviewed. Sustained virological response (SVR) rate and adherence to therapy were taken as the endpoints of interest.

Results: A total of 603 patients from 16 studies were included in the systematic review. Of 372 patients who underwent SO followed by antiviral treatment, the total SVR rate was 39.5%. SVR was associated with HCV genotypes 2/3 (OR = 10.84; 95%CI: 5.47-21.47; P < 0.00001). IFN-α dose needed to be reduced in 29.4%, and IFN-α-based therapy was discontinued in 11.5% of patients. Analysis of controlled studies showed that SVRs were achieved in 34.1% of patients with SO and 31.1% of patients without SO. SO had no effect on the SVR rate in cirrhotic patients with genotype 1 HCV infection (OR = 1.28; 95%CI: 0.51-3.22; P = 0.60), but improved the SVR rate in patients with genotypes 2/3 infection, though the difference was not significant (OR = 0.36; 95%CI: 0.13-1.02; P = 0.05).

Conclusion: SO combined with IFN-α-based antiviral therapy may be suitable in cirrhotic patients with genotypes 2/3 HCV infection, but not in those with genotype 1 infection.

Keywords: Hepatitis C virus cirrhosis; Interferon, Ribavirin; Partial splenic embolization; Splenectomy.

Figure 1

Flowchart of selection of studies for inclusion.

Figure 2

Impact of hepatitis C virus genotype on antiviral treatment outcomes in cirrhotic patients with spleen operation.

Figure 3

Impact of spleen operation on sustained virological response in six controlled studies. SO: Spleen operation; Non-SO: No spleen operation.

Figure 4

Impact of spleen operation on sustained virological response of different hepatitis C virus genotypes in controlled studies. Spleen operation did not increase sustained virological response rate in cirrhotic patients with genotype 1 hepatitis C virus infection (A), but did improve virological response in genotypes 2/3-infected individuals (B). SO: Spleen operation; Non-SO: No spleen operation.

Figure 5

Comparison of adherence to antiviral therapy in controlled studies. The random-effects model showed that spleen operation decreased the incidence of interferon (IFN) dosage reduction (A). There was no significant difference in withdrawal of IFNα-based therapy between patients with SO plus IFN and those with IFNα treatment alone (B). SO: Spleen operation; Non-SO: No spleen operation.