Cyclosporine versus Tacrolimus After Liver Transplant for Hepatitis C: A Single Center Randomized Controlled Trail and Meta-Analysis

BACKGROUND: This study combines data from our own trial with two previous trials to form a meta-analysis that investigates the difference in survival and rejection rates of patients treated with tacrolimus (FK) as compared to cyclosporine (CYA) after liver transplant for hepatitis C virus (HCV). MATERIALS AND METHODS: We performed a prospective randomized trial of patients undergoing liver transplant for HCV but this was limited due to inadequate sample size. Using standard meta-analysis techniques, two studies from the literature were combined with our data to yield a total of 185 patients for analysis. A fixed effects analysis using Mantel-Haenszel methods was used to account for individual study effects in estimating the overall difference between FK and CYA. Risk ratios (RR) were computed comparing risk of one-year rejection and mortality between FK and CYA. RESULTS: Using combined data, the one year mortality risk of FK (23.9%) and CYA (23.7%) did not show a statistically significant difference (RR = 1.00, 95% CI 0.60 - 1.67, p=0.99). When comparing the rejection rates after one year of FK (31.5%) to CYA (39.8%), there was no statistically significant difference (RR = 0.79, 95% CI 0.53 – 1.17, p=0.24). Altschuler: HCV immunosuppression Page 3 CONCLUSIONS: This study provides a more precise estimate of the difference in risk (and therefore equivalence) of mortality and rejection after one year between FK and CYA in patients after liver transplant for hepatitis C. This suggests that transplant teams should not base calcineurin inhibitor immunosuppression choices on the HCV status in the recipient.

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