Antiviral treatment withdrawal in viremic HCV‐positive liver transplant patients: impact on viral loads, allograft function and morphology

Kornberg, Arno; Küpper, B.; Tannapfel, Andrea; Thrum, Katharina; Barthel, Erik R.; Settmacher, Utz

doi:10.1111/j.1478-3231.2006.01301.x

Cited by 12 publications

(21 citation statements)

References 22 publications

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“…In cases of hepatitis B, high serum levels of hepatitis B virus DNA are usually found, and several reports have shown an accumulation of large amounts of hepatitis B virus antigens in hepatocytes. Recently, reports of FCH have been increasing in cases of hepatitis C after LTx [13][14][15]20]. In recurrent hepatitis C after LTx, several researchers have indicated that FCH is caused by a direct cytopathic effect of HCV associated with a high level of HCV replication [9][10][11][12].…”

Section: Discussionmentioning

confidence: 98%

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Fibrosing cholestatic hepatitis with hepatitis C virus treated by double filtration plasmapheresis and interferon plus ribavirin after liver transplantation

Miyake

Michitaka

Terada

et al. 2009

Clin J Gastroenterol

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Fibrosing cholestatic hepatitis (FCH) is a serious disease in patients with recurrent hepatitis C after liver transplantation (LTx). Antiviral therapy is indicated in these patients; however, it is not always effective, and the prognosis of FCH is generally poor. Double filtration plasmapheresis (DFPP) has been shown to be effective at eliminating hepatitis C virus (HCV) in patients with chronic hepatitis C. We report a case of FCH with severe cholestasis (total bilirubin 34.2 mg/dl) after LTx. Combination therapy with interferon (IFN) and ribavirin (RBV) was unsuccessful for improving cholestasis; however, the addition of DFPP to IFN and RBV alleviated cholestasis and improved renal function. Although IFN and RBV with DFPP could not eliminate HCV, results of liver function tests improved and remained stable for several months. This treatment with DFPP combined with IFN and RBV would be useful for resolving cholestasis due to FCH. Moreover, treatment of DFPP could improve liver and renal function test results and could stop the worsening condition of patients with FCH.

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Section: Discussionmentioning

confidence: 98%

“…Antiviral therapy with IFN, with or without RBV, has been used in these patients. A few cases have reported successful results, but the prognosis of FCH is generally poor [14,15].…”

Section: Introductionmentioning

confidence: 97%

Fibrosing cholestatic hepatitis with hepatitis C virus treated by double filtration plasmapheresis and interferon plus ribavirin after liver transplantation

Miyake

Michitaka

Terada

et al. 2009

Clin J Gastroenterol

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“…Due to IFN-associated side effects and RBV-induced anemia, antiviral treatment of HCV infection after LT is challenging. Treatment-associated rejection episodes and a flare of liver disease may have resulted in graft failure and ultimately in patient death 12,21,22. With the approval of DAAs, standard of care has changed to a combination therapy with DAAs, in the beginning in combination with PEG-IFN and RBV 23,24.…”

Section: Introductionmentioning

confidence: 99%

Efficacy and safety of direct-acting antiviral therapy in previous hard-to-treat patients with recurrent hepatitis C virus infection after liver transplantation: a real-world cohort

Bernuth¹,

Grimm²,

Vollmar³

et al. 2017

DDDT

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BackgroundRecurrent hepatitis C virus (HCV) infection after liver transplantation (LT) has been a frequent and relevant problem in the past two decades. This analysis evaluated the efficacy and safety of new interferon (IFN)-free direct-acting antiviral (DAA) therapies in a large real-world cohort of HCV patients after LT.MethodsWe retrospectively analyzed a cohort of 157 patients infected with HCV who underwent deceased donor LT between 1997 and 2014. Patient survival, outcome, and side effects of antiviral therapy were assessed.ResultsSurvival with recurrent HCV genotype 1 (GT1) infection was inferior to other HCV GTs (P=0.01). The overall sustained virological response (SVR) rate with new DAA therapy was 94.6% (n=37). Patients with both GT1 and other GTs reached SVR rates >90%. We noticed a few side effects, mainly caused by ribavirin, and only one discontinuation in DAA-treated patients.ConclusionDAA therapy was effective and safe in previous hard-to-treat patients after LT in this real-world cohort.

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“…In contrast, although HCV reactivation following immunosuppressive therapy is rare, fibrosing cholestatic hepatitis C (FCH) occurs in HCV positive liver transplant recipients with immunosuppressive therapy . Whether immunosuppressive therapy leads to HCV reactivation in patients with cancer in whom the infection has cleared either spontaneously or secondary to therapy is uncertain.…”

Section: Pathophysiology Of Reactivation Of Hbv and Hcv Infectionmentioning

confidence: 99%

Reactivation of hepatitis viruses following immunomodulating systemic chemotherapy

Watanabe

Tanaka

2012

Hepatology Research

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Reactivation of hepatitis B virus (HBV) or hepatitis C virus (HCV) infection following anticancer chemotherapy and immunosuppressive therapy is a well-known complication. HBV reactivation has been reported to be associated with anti-CD20 monoclonal antibody rituximab-containing chemotherapy and tumor necrosis factor-a inhibitor-containing immunosuppressive therapy in HBV resolved patients (hepatitis B surface antigen negative and antibodies against hepatitis B core antigen positive and/or antibodies against surface antigen positive). On the other hand, HCV reactivation has been reported to be associated with liver damage or hepatic dysfunction, but fulminant hepatitis due to HCV reactivation is a rare complication. In this review, we describe the pathophysiology of the reactivation of HBV and HCV infection, as well as the clinical evidence and management of HCV reactivation.

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Antiviral treatment withdrawal in viremic HCV‐positive liver transplant patients: impact on viral loads, allograft function and morphology

Abstract: Our study suggests that antiviral treatment withdrawal carries the risk of severe disease progression in persistently viremic HCV-positive liver transplant patients.

Cited by 12 publications

References 22 publications

Fibrosing cholestatic hepatitis with hepatitis C virus treated by double filtration plasmapheresis and interferon plus ribavirin after liver transplantation

Fibrosing cholestatic hepatitis with hepatitis C virus treated by double filtration plasmapheresis and interferon plus ribavirin after liver transplantation

Efficacy and safety of direct-acting antiviral therapy in previous hard-to-treat patients with recurrent hepatitis C virus infection after liver transplantation: a real-world cohort

Reactivation of hepatitis viruses following immunomodulating systemic chemotherapy

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