Slower Fibrosis Progression Among Liver Transplant Recipients With Sustained Virological Response After Hepatitis C Treatment

Abstract

BackgroundThe natural course of hepatic fibrosis in HCV allograft recipients with sustained virological response (SVR) after anti-HCV therapy remains debatable. The aim of this study was to examine the progression of fibrosis in a cohort of patients who achieved SVR compared with those without treatment.MethodsThe 167 patients who met the inclusion and exclusion criteria were chosen from a transplant database. All patients were required to have histological evidence of recurrent HCV infection post-liver transplantation and a follow-up biopsy. The 140 of these patients had received anti-viral therapy. Twenty-seven patients were identified as controls and were matched with the treatment group in all respects. The patients were categorized into four groups based on treatment response: 1) no treatment (control) (n = 27); 2) non-responders (n = 81); 3) relapsers (n = 32); and 4) SVR (n = 27). The endpoint was the stage of fibrosis on the follow-up liver biopsy.ResultsThe treated and untreated groups were similar in clinical characteristics at the time of transplantation and prior to the initiation of treatment. The 72% of the cohort showed a fibrosis progression of ≥ 1 stage; this change did not significantly differ between the patient groups. Nonetheless, the fibrosis progression rate was the highest in the untreated group and lowest in the patients who achieved SVR. A coefficient of determination was used. Improvements in fibrosis scores were found with greater treatment duration. These improvements were most evident with the achievement of SVR.ConclusionsIn conclusion, SVR after anti-viral therapy for recurrent hepatitis C infection post-transplantation was associated with slower fibrosis progression and significantly improved graft survival.

Multitarget Direct‐Acting Antiviral Therapy Is Associated With Superior Immunologic Recovery in Patients Coinfected With Human Immunodeficiency Virus and Hepatitis C Virus

“…Treatment of HIV with antiretroviral therapy and treatment of HCV have independently been shown to delay the progression of fibrosis and end‐stage liver disease among coinfected patients . However, the rates of SVR with immune‐based methods based on peginterferon (PEG‐IFN) and ribavirin therapy have been significantly inferior among coinfected patients compared to patients monoinfected with HCV, the reasons for which have not been fully elucidated .…”

Successful combination of direct antiviral agents in liver-transplanted patients with recurrent hepatitis C virus

“…Importantly, we recognized no serious harmful effects on transplant function, as no patient experienced an episode of acute cellular rejection or required re-transplantation during or immediately after the antiviral therapy. Most patients showed improvement of liver function after the end of therapy, which might improve graft survival in the future[ 29 ].…”

“…Both patients had recurrent cirrhosis and were transplanted more than 5 years ago. These patients might represent a subgroup of patients that have reached a point of no return, as HCV infection has already caused severe damage to the liver graft, which cannot be reverted even by successful antiviral therapy[ 29 - 32 ].…”

Multicenter, Double‐Blind, Randomized Trial of Emricasan in Hepatitis C–Treated Liver Transplant Recipients With Residual Fibrosis or Cirrhosis

“…Previous studies using paired biopsies in this patient population were limited, variable, and mainly from patients treated with interferon-based therapies; patients in these studies were also at variable times post SVR. (27,(32)(33)(34) The population selected in the post-liver transplant state should have been those who had inflammatory activity leading to and perpetuating fibrosis. In contemporaneous studies, emricasan was shown to have negligible effects on NASH in multiple cohorts-those with NASH, compensated NASH cirrhosis, and decompensated NASH cirrhosis.…”