Recurrence of hepatitis C virus (HCV) infection after liver transplantation (LT) is universal. However, the efficacy, tolerability and safety of combination interferon and ribavirin (IFN– RIB) or peginterferon and ribavirin (PEG– RIB) anti-viral therapies post-LT are uncertain. We performed a comprehensive search of major medical databases (1980– 2005) and conference proceedings (1996– 2005). The main outcome measure was sustained virological response (SVR, undetectable HCV RNA) at 6 months. Summary estimates were calculated using random-effects models. Twenty-seven IFN– RIB and 21 PEG– RIB studies were included. IFN– RIB was associated with a pooled SVR rate of 24% (95% CI, 20– 27%), while PEG– RIB was associated with an SVR rate of 27% (23– 31%). Pooled discontinuation rates were 24% (21– 27%) with IFN– RIB and 26% (20– 32%) with PEG– RIB. The pooled rate of acute graft rejection was 2% (1– 3%) with IFN– RIB and 5% (3– 7%) with PEG– RIB. IFN– RIB and PEG– RIB therapies in HCV infection post-LT were associated with similar but overall low SVR and were poorly tolerated. The rate of acute rejection was small. The therapeutic advantage of PEG– RIB therapy observed in non-transplant chronic HCV infection appears to be attenuated post-LT. Clinical trials are needed to evaluate reasons for this post-transplant therapeutic disadvantage and to find strategies to ameliorate them.
