Meta-Analysis
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World J Gastroenterol. Nov 7, 2014; 20(41): 15387-15397
Published online Nov 7, 2014. doi: 10.3748/wjg.v20.i41.15387
Effect of spleen operation on antiviral treatment in hepatitis C virus-related cirrhotic patients
Bo Feng, Wei Zhang, Bi-Fen Luo, Guang-Jun Song, Jian Wang, Qian Jin, Hong Qin, Lai Wei
Bo Feng, Wei Zhang, Bi-Fen Luo, Guang-Jun Song, Jian Wang, Qian Jin, Hong Qin, Lai Wei, Peking University People’s Hospital, Peking University Hepatology Institute, Beijing Key Laboratory of Hepatitis C and Immunotherapy for Liver Diseases, Beijing 100044, China
Author contributions: Feng B contributed to study design, data acquisition, statistical analysis and drafted the manuscript; Zhang W contributed to data acquisition and statistical analysis; Luo BF and Song GJ participated in study planning and statistical analysis; Wang J participated in study design and data analysis; Jin Q and Qin H contributed to data acquisition and statistical analysis; Wei L participated in study design, funding analysis and manuscript drafting; and all authors read and approved the final manuscript.
Supported by National S and T Major Project for Infectious Diseases Control, No. 2012ZX10002-003; National Major S and T Special Project for “Significant New Drugs Development”, No. 2012ZX09303-019; and Beijing Natural Science Foundation, No. 7122191
Correspondence to: Lai Wei, MD, Professor, Peking University People’s Hospital, Peking University Hepatology Institute, Beijing Key Laboratory of Hepatitis C and Immunotherapy for Liver Diseases, No. 11 Xizhimen South Street, Beijing 100044, China. weilai@pkuph.edu.cn
Telephone: +86-10-88325566 Fax: +86-10-68322662
Received: January 19, 2014
Revised: March 25, 2014
Accepted: June 26, 2014
Published online: November 7, 2014
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, Splenectomy, Partial splenic embolization

Core tip: Hematologic abnormalities caused by hypersplenism and interferon-α (IFN-α) severely affect IFN-α-based therapy in cirrhotic patients with hepatitis C virus (HCV) infection. Splenectomy and partial splenic embolization followed by IFN-α-based therapy have been increasingly performed to address cytopenias, including thrombocytopenia, in patients with HCV-related cirrhosis with hypersplenism. However, the therapeutic effect and long-term safety of such treatments remain controversial. We performed a systematic review and demonstrated that spleen operation can improve hematologic parameters before and during IFN-α-based antiviral therapy in cirrhotic patients infected with HCV. However, this treatment is more suitable for patients with genotypes 2/3 HCV infection than for those with genotype 1.