Combined treatment with pegylated interferon (α-2b) and ribavirin in the acute phase of hepatitis C virus recurrence after liver transplantation

Castells, Lluı́s; Vargas, Vı́ctor; Allende, Helena; Bilbao, Itxarone; Lázaro, José; Margarit, C; Esteban, Rafael; Guàrdia, J

doi:10.1016/j.jhep.2005.02.015

Cited by 143 publications

(138 citation statements)

References 35 publications

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“…A previous study with an early intervention strategy reported sustained virologic response rate 34.7%, but eligibility for that study was low (56%). 25 In the present study, eligibility for PEG-IFN and ribavirin also was low (50%). Combination therapy in liver transplant patients may be associated with frequent and severe adverse events, including the frequent need for erythropoietin and/or filgrastim.…”

contrasting

confidence: 48%

Recurrent Hepatitis C Virus Infection and Outcome After Living-Donor Liver Transplant

Fiel

Vanatta

Marti

et al. 2013

Exp Clin Transplant

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Objectives: In living-donor liver transplant recipients with hepatitis C virus infection, outcomes of recurrent hepatitis C virus infection and fibrosis progression are not well documented. We evaluated fibrosis progression, response to pegylated interferon treatment, and long-term graft survival in living-donor liver transplant recipients who had hepatitis C virus infection. Materials and Methods: In 48 transplant recipients, including 29 recipients who had follow-up liver biopsy ≥ 6 months after transplant, histology and clinical courses were reviewed. Outcomes were evaluated for patients grouped into slow and rapid fibrosis groups. Treatment with pegylated interferon and ribavirin was assessed in 18 patients. Results: Clinical features were similar between recipients with slow or rapid fibrosis. The time interval from transplant to recurrence of hepatitis C virus infection was significantly shorter in the recipients with rapid fibrosis. Recipients with rapid fibrosis had significantly greater confluent necrosis, acidophil bodies, and fibrosis score than recipients with slow fibrosis. Graft survival rates were similar between patients with slow or rapid fibrosis. Cumulative proportion of long-term graft survival was 60% at 7 years after transplant. Sustained virologic response was noted in 5 of 18 patients (28%) who received pegylated interferon and ribavirin. Conclusions: In recipients of living-donor liver transplant with early recurrence of hepatitis C have worse fibrosis progression but graft survival was not affected. Therapy with pegylated interferon and ribavirin achieved sustained virologic response only in a small proportion of the patients.

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contrasting

confidence: 48%

Recurrent Hepatitis C Virus Infection and Outcome After Living-Donor Liver Transplant

Fiel

Vanatta

Marti

et al. 2013

Exp Clin Transplant

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“…[93][94][95][96]98,99,102,105,106,109,110,127,145,146 Most published studies are uncontrolled trials with a high variability in patient selection, and type and timing of antiviral therapy. Rates of SVR have been less than those achieved in the nontransplant setting.…”

Section: Peg-ifn Plus Ribavirinmentioning

confidence: 99%

“…112 Whether this 12-week stopping rule applies equally to transplant recipients with recurrent hepatitis C has not been conclusively determined, but data from recent studies suggest that the role of EVR in predicting treatment outcome among liver transplant recipients is comparable to that in the nontransplant setting. 104,106,107,110 EVR represents an important predictor of treatment outcome and may be considered a reliable indicator that treatment should be stopped if it is not attained. At present, attainment of EVR is the only factor shown by multivariate analysis to be significantly associated with SVR.…”

Section: Factors Affecting Therapy Duration Of Ifn Therapymentioning

confidence: 99%

“…161 Treatment with PEG-IFN plus ribavirin was administered in most studies over a duration of 12 months. 94,96,98,99,101,[104][105][106][107][108][109][110] The question of whether genotype 2 and 3 can be treated for a shorter time or if it is necessary to prolong therapy in patients with delayed virological response and high baseline viral loads as recommended in the nontransplant setting remains also to be answered. In the transplant setting many studies pool genotype 1 and non-1, resulting in higher overall SVR rates, since genotype 2 and 3 are known to result in better SVR rates.…”

Section: Factors Affecting Therapy Duration Of Ifn Therapymentioning

confidence: 99%

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Managing hepatitis C in liver transplant patients with recurrent infection

Zimmermann¹,

Otto²,

Schuchmann

2009

TRRM

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“…A recent study has established that the best treatment results for patients with established HCV recurrence were obtained from PEG-IFN/RBV treatment [9]. Patients who achieved SVR (20-30 %) showed slower disease progression and longer term graft survival compared to non-responders [10][11][12]. A higher proportion of genotype 1 disease, poor adherence to therapy or lower drug doses, and severe complications were responsible to lower SVR rates in these patients.…”

mentioning

confidence: 99%

The prediction of immunological dysfunction during antiviral therapy for HCV after liver transplantation: can we improve outcomes?

Zhang

et al. 2013

Hepatol Int

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Much research has focused on the incidence and clinical characteristics of recurrent hepatitis C in liver transplantation (LT) patients during and after pegylated-interferon and ribavirin (PEG-IFN/RBV) therapy. These patients are generally characterized by a high prevalence of recurrent hepatitis C, a more aggressive rate of disease progression and low survival rates. Recurrent hepatitis C usually results from repeated therapy using corticosteroid and anti-lymphocyte antibodies [1]. Based on histological evidence, 50-90 % of patients who undergo LT develop recurrent HCV within 12 months, and 20-30 % of patients develop liver cirrhosis within 5 years [2,3]. Patients with recurrent hepatitis C after LT have a 56.7 % of 5-year survival rate, which is significantly lower than that in HCV-negative patients [4,5]. Furthermore, it is difficult to treat recipients with recurrent HCV recurrence [6]. The rate of sustained virological response (SVR) in these patients is frequently lower because of limited therapeutic options and potential immunological complications. Therefore, the treatment for post-LT patients with recurrent hepatitis C remains a significant clinical challenge.Preemptive antiviral treatment and the treatment of established recurrent hepatitis C have been adopted in some clinical settings. Preemptive treatment refers to early antiviral therapy, which is given within days or weeks after LT in all patients, despite histological evidence of recurrence. However, 30 % of patients do not tolerate this treatment well, and half of the patients require drug dose reduction [7]. One randomized trial evaluated the efficacy of preemptive anti-HCV therapy and found that only 9 % of patients achieved SVR [8]. The treatment of established HCV recurrence can involve patients who are most likely to achieve the benefit from antiviral therapy, whereas patients without HCV recurrence can avoid the side effects. A recent study has established that the best treatment results for patients with established HCV recurrence were obtained from PEG-IFN/RBV treatment [9]. Patients who achieved SVR (20-30 %) showed slower disease progression and longer term graft survival compared to non-responders [10][11][12]. A higher proportion of genotype 1 disease, poor adherence to therapy or lower drug doses, and severe complications were responsible to lower SVR rates in these patients.However, the efficacy of PEG-IFN/RBV treatment for post-LT patients with HCV recurrence is negatively affected by immunological dysfunction (ID), which includes acute cellular rejection (ACR), plasma cell/autoimmune hepatitis and chronic rejection [13][14][15][16][17]. ID usually occurs together with LT and recurrent hepatitis C during or after PEG-IFN/RBV therapy, and it is recognized as a unique clinical entity. Patients who develop ID are at risk of lower long-term survival rates, higher re-transplantation rates and fewer increases in the rate of SVR. In a multicenter case-controlled retrospective study, certain risk factors, including no prior PEG-IFN therapy...

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Combined treatment with pegylated interferon (α-2b) and ribavirin in the acute phase of hepatitis C virus recurrence after liver transplantation

Cited by 143 publications

References 35 publications

Recurrent Hepatitis C Virus Infection and Outcome After Living-Donor Liver Transplant

Recurrent Hepatitis C Virus Infection and Outcome After Living-Donor Liver Transplant

Managing hepatitis C in liver transplant patients with recurrent infection

The prediction of immunological dysfunction during antiviral therapy for HCV after liver transplantation: can we improve outcomes?

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