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

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 including1214 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.