Safety of Anti-TNF Treatment in Liver Transplant Recipients: A Systematic Review and Meta-analysis
| Autor: | G.-P. Pageaux, P W J Maljaars, R. Altwegg, M J Westerouen van Meeteren, B. van Hoek, Daniel J. Stein, T. Stijnen, Akin Inderson, Bu'Hussain Hayee, A. Van der Meulen |
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| Jazyk: | angličtina |
| Rok vydání: | 2017 |
| Předmět: |
Graft Rejection
safety medicine.medical_specialty medicine.medical_treatment Cholangitis Sclerosing Liver transplantation Infections Rate ratio Inflammatory bowel disease Primary sclerosing cholangitis 03 medical and health sciences Postoperative Complications 0302 clinical medicine Gastrointestinal Agents Risk Factors inflammatory bowel disease Internal medicine Humans Medicine 030212 general & internal medicine Models Statistical liver transplantation Tumor Necrosis Factor-alpha business.industry Gastroenterology primary sclerosing cholangitis Immunosuppression General Medicine Inflammatory Bowel Diseases medicine.disease Transplantation Anti-Tumor Necrosis Factor Therapy biological therapy Immunology Cohort Regression Analysis 030211 gastroenterology & hepatology business Immunosuppressive Agents |
| Zdroj: | Journal of Crohn's and Colitis, 11(9), 1146-1151 |
| Popis: | Background and aim Little is known about the risk of serious infection when combining anti-tumour necrosis factor [TNF] therapy for refractory inflammatory bowel disease [IBD] with immunosuppression after liver transplantation [LT]. Our aim was to investigate the infection risk in this patient group by systematic review and meta-analysis of the available data. Methods A search was conducted for full papers and conference proceedings through September 2015, regarding liver transplant recipients and anti-TNF therapy. All studies were appraised using the adapted Newcastle-Ottawa Scale [NOS]. Two reviewers independently extracted patient data [age, duration of follow-up, number of all infections, number of serious infections, time since transplant]. As an additional control population, primary sclerosing cholangitis [PSC]-IBD patients from the Leiden University Medical Center [LUMC] LT cohort were used. Poisson regression was used to compare serious infections (according to International Conference on Harmonisation [ICH] definition) per patien-year follow-up between the anti-TNF and control groups. Results In all 465 articles and abstracts were identified, of which eight were included. These contained 53 post-LT patients on anti-TNF therapy and 23 post-LT patients not exposed to anti-TNF therapy. From the LUMC LT-cohort, 41 PSC patients with PSC-IBD not exposed to anti-TNF therapy were included as control population. The infection rate for TNF-exposed patients was 0.168 serious infections per patient year, compared with 0.149 in the control patients (rate ratio 1.12 [95% confidence interval: 0.233-5.404, P = 0.886]. When correcting for time since transplant, the infection rate was 0.194 in the TNF-exposed vs 0.115 in the non-exposed [p = 0.219]. Conclusions No significant increase in the rate of serious infection was observed in LT recipients with PSC-IBD during exposure to anti-TNF therapy. |
| Databáze: | OpenAIRE |
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