Chronic Rejection Associated with Antiviral Therapy for Recurrent Hepatitis C after Living-Donor Liver Transplantation

Ueda, Yoshihide; Kaido, Toshimi; Ito, Takashi; Ogawa, Kohei; Yoshizawa, Atsushi; Fujimoto, Yasuhiro; Mori, Akira; Miyagawa‐Hayashino, Aya; Haga, Hironori; Marusawa, Hiroyuki; Chiba, Tsutomu; Üemoto, Shinji

doi:10.1097/01.tp.0000435702.61642.0a

Cited by 11 publications

(11 citation statements)

References 30 publications

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“…reported that seven of 125 (6%) patients developed chronic rejection during or within 6 months after the end of antiviral therapy. In five patients, rejection progressed rapidly and resulted in death within 3 months after diagnosis . On the other hand, plasma cell hepatitis induced by antiviral therapy for recurrent hepatitis C after LDLT .…”

Section: Discussionmentioning

confidence: 98%

“…In five patients, rejection progressed rapidly and resulted in death within 3 months after diagnosis. 31 On the other hand, plasma cell hepatitis induced by antiviral therapy for recurrent hepatitis C after LDLT. 32,33 Although it is important that SVR induced by IFN therapy improved survival rate in patients with recurrent post-LDLT HCV infection, IFN therapy may be recommended in these patients while we are careful of chronic rejection and plasma cell hepatitis.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Sustained virological response to antiviral therapy improves survival rate in patients with recurrent hepatitis C virus infection after liver transplantation

Kawaoka

Takahashi

Kawakami

et al. 2014

Hepatology Research

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Section: Discussionmentioning

confidence: 98%

Section: Discussionmentioning

confidence: 99%

Sustained virological response to antiviral therapy improves survival rate in patients with recurrent hepatitis C virus infection after liver transplantation

Kawaoka

Takahashi

Kawakami

et al. 2014

Hepatology Research

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“…However, IFN‐mediated graft dysfunction is a significant clinical problem that warrants particular caution following living donor LT . Moreover, it was reported that IFN‐based antiviral therapy for recurrent hepatitis C after living donor LT had the potential for causing plasma cell hepatitis and chronic rejection . Therefore, for such difficult‐to‐treat post‐LT patients, IFN‐free daclatasvir and asunaprevir combination therapy will likely be a standard therapy …”

Section: Discussionmentioning

confidence: 99%

Three patients treated with daclatasvir and asunaprevir for recurrent hepatitis C after liver transplantation: Case report

Kawaoka

Imamura

Morio

et al. 2015

Hepatology Research

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We previously reported our data on telaprevir or simeprevir used in combination with pegylated interferon (PEG IFN) and ribavirin (RBV) for the treatment of recurrent hepatitis C virus (HCV) genotype 1 infection after liver transplantation (LT). Here, we report three patients who achieved viral responses with no effect on the blood concentrations of immunosuppressive agents following daclatasvir and asunaprevir treatment. The first patient was a 57-year-old man with HCV-related liver cirrhosis who failed to respond to PEG IFN/RBV after living donor LT. He had been treated with 1 mg/day of tacrolimus. The second was a 63-year-old man with HCV-related liver cirrhosis and hepatocellular carcinoma who failed to respond to PEG IFN/RBV after living donor LT. He had been treated with 1 mg/day of tacrolimus. The third was a 61-year-old man with HCV-related liver cirrhosis. He had been treated with mycophenolate mofetil (MMF). Serum HCV RNA became undetectable by TaqMan polymerase chain reaction test after 4 weeks of daclatasvir and asunaprevir treatment in all patients, and no remarkable fluctuations in blood concentration were observed either in tacrolimus or in MMF during 24 weeks of therapy. No adverse events were observed, and all patients received the full dose of daclatasvir and asunaprevir over 24 weeks. Serum HCV RNA remained negative at 12 weeks after the end of treatment in all patients. The daclatasvir and asunaprevir treatment showed a remarkable viral response with little effect on blood levels of immunosuppressive agents for recurrent HCV genotype 1 infection after LT.

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“…65 Several uncontrolled studies have suggested that CR may be related to IFN-based therapy (incidence range 4-17%). 64,66 CR is generally detected after one year of therapy and is often observed concurrent with the absence or low levels of hepatitis C viremia. Notably, the majority of patients had not experienced ACR during treatment and yet evolved to CR.…”

Section: Rejection and Autoimmune Complicationsmentioning

confidence: 99%

“…64 It should be noted that IFN-related CR may be partly preventable by ensuring that the immunosuppressant dose is not reduced during antiviral therapy. 66 Autoimmune hepatitis (AIH)-like hepatitis after LT has been reported in HCV patients, particularly with IFN-based therapy. 19,64,67 The histological hallmarks can somewhat resemble classical AIH, including plasma cell-predominant periportal infiltrates with interface hepatitis or so called plasma cell-rich hepatitis.…”

Section: Rejection and Autoimmune Complicationsmentioning

confidence: 99%

Management of Hepatitis C Before and After Liver Transplantation in the Era of Rapidly Evolving Therapeutic Advances

Bunchorntavakul¹,

Reddy²

2014

JCTH

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Management of hepatitis C (HCV) in liver transplantation (LT) population presents unique challenges. Suboptimal graft survival in HCV+ LT recipients is attributable to universal HCV recurrence following LT. Although eradication of HCV prior to LT is ideal for the prevention of HCV recurrence it is often limited by adverse events, particularly in patients with advanced cirrhosis. Antiviral therapy in LT candidates needs careful monitoring, and prophylaxis with HCV antibodies is ineffective. Early antiviral therapy after LT has been investigated, but no clear benefit has been demonstrated. Protocol liver biopsy is generally recommended in HCV+ LT recipients, and antiviral therapy can be considered in those with severe/ progressive HCV recurrence. Sustained virological response (SVR) can be achieved in approximately 30% of LT recipients with pegylated interferon/ribavirin (PEG-IFN/RBV) with survival benefit, but adverse effects are common. Favorable patient characteristics for response to therapy include non-1 genotype, previously untreated, low baseline HCV-RNA, and donor IL28B genotype CC. Direct acting antiviral (DAA)-based triple therapy is associated with higher rates of SVR, but with similar or slightly higher rates of side effects, and immunosuppressive regimens need to be closely monitored and adjusted during the treatment period. Notably, the safety and efficacy of HCV treatment are very likely to improve with newer generation DAA. The benefit of immunosuppressive strategy on the natural history HCV recurrence has not been well elucidated. Based upon available evidence, cyclosporine A (CSA), mycophenolate mofetil (MMF), and sirolimus appear to have a neutral or small beneficial impact on HCV recurrence. Donor interleukin 28 B (IL28B) polymorphisms appear to impact the course and treatment outcomes in recurrent HCV. Retransplantation should be considered for patients with reasonable survival probability.

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Chronic Rejection Associated with Antiviral Therapy for Recurrent Hepatitis C after Living-Donor Liver Transplantation

Abstract: CR developed in association with antiviral therapy for recurrent hepatitis C after LDLT. This complication may be prevented by ensuring that the immunosuppressant dose is not reduced during antiviral therapy.

Cited by 11 publications

References 30 publications

Sustained virological response to antiviral therapy improves survival rate in patients with recurrent hepatitis C virus infection after liver transplantation

Sustained virological response to antiviral therapy improves survival rate in patients with recurrent hepatitis C virus infection after liver transplantation

Three patients treated with daclatasvir and asunaprevir for recurrent hepatitis C after liver transplantation: Case report

Management of Hepatitis C Before and After Liver Transplantation in the Era of Rapidly Evolving Therapeutic Advances

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