Antiviral therapy increases the risk of bacterial infections in HCV-infected cirrhotic patients awaiting liver transplantation: A retrospective study

Carrión, J.A.; Martínez–Bauer, Eva; Crespo, Gonzalo; Ramírez, Santseharay; Pérez‐del‐Pulgar, Sofía; García‐Valdecasas, Juan Carlos; Navasa, Miquel; Forns, Xavier

doi:10.1016/j.jhep.2008.11.015

Cited by 175 publications

(176 citation statements)

References 29 publications

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“…Predictors of viral clearance include non-genotype 1 and an early virological response [22][23][24][25] . The absence of a ≥ 2 log10 reduction in HCV RNA between baseline and wk 4 has a strong negative predictive value [22][23][24]26,27] . This absence of an early virological response can be used as a guide to stopping treatment [26] .…”

Section: Predictors Of Antiviral Therapy Response and Tolerancementioning

confidence: 99%

“…The absence of a ≥ 2 log10 reduction in HCV RNA between baseline and wk 4 has a strong negative predictive value [22][23][24]26,27] . This absence of an early virological response can be used as a guide to stopping treatment [26] . Pre transplant higher viral load has been reported as another predictor of SVR [22,25] .…”

Section: Predictors Of Antiviral Therapy Response and Tolerancementioning

confidence: 99%

“…Many of the reported studies were designed to focus on the safety and tolerability of AVT, rather than HCV recurrence patterns and clinical course post LTx [22][23][24][26][27][28][29][30][31] . A number of different antiviral regimens and treatment periods have been studied.…”

Section: Evidence Regarding Pre-transplant Antiviral Therapymentioning

confidence: 99%

“…The actual number of patients who were HCV RNA negative coming to transplant was small. Of the responders, up to 80% remained HCV RNA negative after transplant [22,23,26] but long-term follow up was limited. From the available data, in the selected few, AVT can render the patient HCV RNA negative post transplant but the long-term benefit has not yet been fully established to justify the cost and clinical risk.…”

Section: Evidence Regarding Pre-transplant Antiviral Therapymentioning

confidence: 99%

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Strategies to reduce hepatitis C virus recurrence after liver transplantation

Ciria

Pleguezuelo²,

Khorsandi³

et al. 2013

WJH

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Hepatitis C virus (HCV) is a major health problem that leads to chronic hepatitis, cirrhosis and hepatocellular carcinoma, being the most frequent indication for liver transplantation in several countries. Unfortunately, HCV re-infects the liver graft almost invariably following reperfusion, with an accelerated history of recurrence, leading to 10%-30% of patients progressing to cirrhosis within 5 years of transplantation. In this sense, some groups have even advocated for not retransplanting this patients, as lower patient and graft outcomes have been reported. However, the management of HCV recurrence is being optimized and several strategies to reduce post-transplant recurrence could improve outcomes, decrease the rate of re-transplantation and optimize the use of available grafts. Three moments may be the focus of potential actions in order to decrease the impact of viral recurrence: the pretransplant moment, the transplant environment and the post-transplant management. In the pre-transplant setting, it is not well established if reducing the pre transplant viral load affects the risk for HCV progression after transplant. Obviously, antiviral treatment can render the patient HCV RNA negative post transplant but the long-term benefit has not yet been fully established to justify the cost and clinical risk. In the transplant moment, factors as donor age, cold ischemia time, graft steatosis and ischemia/reperfusion injury may lead to a higher and more aggressive viral recurrence. After the transplant, discussion about immunosuppression and the moment to start the treatment (prophylactic, pre-emptive or once-confirmed) together with new antiviral drugs are of interest. This review aims to help clinicians have a global overview of posttransplant HCV recurrence and strategies to reduce its impact on our patients.

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Section: Predictors Of Antiviral Therapy Response and Tolerancementioning

confidence: 99%

Section: Predictors Of Antiviral Therapy Response and Tolerancementioning

confidence: 99%

Section: Evidence Regarding Pre-transplant Antiviral Therapymentioning

confidence: 99%

Section: Evidence Regarding Pre-transplant Antiviral Therapymentioning

confidence: 99%

See 2 more Smart Citations

Strategies to reduce hepatitis C virus recurrence after liver transplantation

Ciria

Pleguezuelo²,

Khorsandi³

et al. 2013

WJH

View full text Add to dashboard Cite

show abstract

“…1 Studies of patients with compensated cirrhosis as well as portal hypertension and poor liver function (platelet count 100,000/mm 3 and serum albumin level < 35 g/L) who were treated with protease inhibitor-based therapy have demonstrated a potential benefit in terms of the prevention of posttransplant HCV recurrence, but they have also emphasized the poor tolerability of this therapy by this group of patients. 2,3 New direct-acting anti-HCV drugs that can be used in interferon-free combination strategies are now available. 4 In October 2013, a 67-year-old woman who was chronically infected with HCV genotype 4 and was a null responder to pegylated interferon a and ribavirin presented with decompensated cirrhosis and rapid degradation of her liver function during the last 6 months, and liver transplantation was indicated.…”

Section: To the Editorsmentioning

confidence: 99%