Pegylated Interferon Alpha-2b for Patients with HCV Recurrence and Graft Fibrosis Following Liver Transplantation

Heydtmann, Mathis; Freshwater, D; Dudley, Tracey; Lai, Vincent S.; Palmer, Stephen; Hübscher, Stefan G.; Mutimer, David

doi:10.1111/j.1600-6143.2006.01255.x

Cited by 34 publications

(27 citation statements)

References 50 publications

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“…and ribavirin combination [5]. Experience with pegylated interferon in combination with ribavirin in the post-transplantation setting is limited [13][14][15][16][17][18][19][20][21][22][23][24][25].…”

Section: Multivariable Analysismentioning

confidence: 99%

Untitled

2013

J Surg

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Hepatitis C in the liver allograft recipient has an aggressive course. A significant proportion of such recipients develop graft fibrosis and cirrhosis within five years of transplantation. Treatment efficacy with standard or pegylated interferon and ribavirin is suboptimal compared to the immunocompetent individuals. However, the effect of such therapy on graft and patient survival remains unknown. Objectives:To determine the efficacy of interferon based therapies in liver transplantation recipients with recurrent hepatitis C, and to determine the effect of interferon treatment on graft and patient survival.

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Section: Multivariable Analysismentioning

confidence: 99%

Untitled

2013

J Surg

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“…In uncontrolled studies the combined use of pegylated interferon and ribavirin proved to be the best strategy, with responses between 30% and 45% [2,[36][37][38].…”

Section: Post-transplant Treatmentmentioning

confidence: 99%

Hepatitis C treatment before and after liver transplant

et al. 2007

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“…The combination of PEG-IFN and RBV may yield SVR in 21% to 45%, with improvements in inflammatory grade and fibrosis stage [31][32][33][34], although 20% to 32% discontinue therapy. A recent report of PEG-IFN monotherapy underscores the difficulty in treating this population: A total of 63 patients were screened, 14 were eligible and treated, four of eight who withdrew due to adverse events had liver dysfunction, six completed 52 weeks of therapy, five had end-of-treatment virological response (EOTR), and only two had SVR [35]. Two reports conflict as to the utility of amantadine plus IFN plus RBV in nonresponders to post-transplant IFN plus RBV therapy [36,37].…”

Section: Post-transplantation Recurrent Hcv Treatmentmentioning

confidence: 99%

Antiviral therapy for hepatitis C in the setting of liver transplantation

Everson

Kulig²

2006

Curr Treat Options Gastro

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Hepatitis C viremia after liver transplantation for hepatitis C virus (HCV) liver disease is universal. Progressive HCV disease after transplantation is the leading cause of death, graft failure, and retransplantation. Whether to treat, with which agents, and timing of therapy are unanswered questions. Timing options include pretransplantation, prophylactic, post-transplantation preemptive, and post-transplantation recurrence-based therapy. The latter is most commonly utilized. There are little data for each of these, much less comparisons. Pegylated interferon-alpha has supplanted standard interferon-alpha due to increased efficacy and is generally used in combination with ribavirin (RBV). Efficacy is less than in nontransplant settings due to immunosuppression, an increased prevalence of genotype 1 HCV, patient comorbidities, and decreased functional status. Administration of HCV therapy to cirrhotic patients prior to transplantation may eradicate or suppress HCV and prevent or reduce severity of recurrence. Sustained virological response (SVR) as high as 50% was attained in genotypes 2 or 3 HCV. Comparison of preemptive and histology-based post-transplantation HCV therapy should be done, and more data will be available on pretransplantation therapy. Post-transplant patients are less tolerant of therapy, particularly RBV. SVR, the primary goal of therapy, likely halts disease progression, but only 20% to 30% of treated patients achieve SVR. Preemptive therapy early after transplantation may have advantages due to the potential to delay or blunt severity of graft infection and recurrent hepatitis. In post-transplant therapy, RBV toxicity is attenuated in relation to decreased renal function, and side effects of interferon are more prominent. An ongoing trial will assess preemptive therapy with treatment after histologic recurrence. Novel anti-HCV therapies such as protease and polymerase inhibitors are emerging. These must be tested with urgency in the transplant setting. Retransplantation for progressive HCV disease is more controversial due to poor outcomes, graft shortage, and disease recurrence.

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Pegylated Interferon Alpha-2b for Patients with HCV Recurrence and Graft Fibrosis Following Liver Transplantation

Cited by 34 publications

References 50 publications

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Hepatitis C treatment before and after liver transplant

Antiviral therapy for hepatitis C in the setting of liver transplantation

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