Spanish society of liver transplantation (SETH) consensus recommendations on hepatitis C virus and liver transplantation

Berenguer, Marina; Charco, Ramón; Pascasio, J.M.; Herrero, J.I.

doi:10.1111/j.1478-3231.2011.02731.x

Cited by 20 publications

(20 citation statements)

References 223 publications

(397 reference statements)

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“…Pre-emptive antiviral treatment in the first few weeks after LT to prevent HCV reinfection has been abandoned largely because of the poor tolerability, high rate of treatment discontinuation and low rate of sustained viro-logical response (SVR) [4–6]. Most investigators have instead focused on the treatment of established recurrent HCV after the first 6 months of LT with ≥stage 2 fibrosis [6, 7].…”

Section: Introductionmentioning

confidence: 99%

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Immunological dysfunction during or after antiviral therapy for recurrent hepatitis C reduces graft survival

et al. 2013

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Introduction Pegylated interferon and ribavirin (PEGIFN/RBV) therapy for recurrent hepatitis C after liver transplantation (LT) is associated with a lower sustained virological response (SVR) rate as well as more frequent side effects compared to non-transplant patients. We aimed to determine the incidence and clinical characteristics of LT recipients with recurrent hepatitis C who developed immunological dysfunction (ID) during or after PEG-IFN/RBV therapy and to assess its impact on patient and graft survival. Methods Seventy-four deceased donor LT recipients with histological recurrence of hepatitis C were treated with PEG-IFN/RBV from 1/00 to 12/08. ID was defined as biopsy-proven rejection or moderate plasma cell hepatitis. Patients were followed up until death, re-LT or 30 September 2011. Results Twelve patients (16 %) had ID, 8 (10.7 %) had cholestasis without ID, while 54 had no ID/cholestasis during or after discontinuation of PEG-IFN/RBV therapy. Biopsy-proven acute cellular rejection prior to (hazard ratio = 4.87, p = 0.009) and type of immunosuppression at the time of initiation of PEG-IFN/RBV were the only independent predictors of ID. Patients who were on tacrolimus at the time of initiation of PEG-IFN/RBV had a significantly lower risk of ID compared to those who were on cyclosporine (HR 0.254, p = 0.023). Patients with ID had a trend toward a lower SVR rate (25 vs. 54 %, p = 0.18) and a significantly higher rate of graft failure (33 vs. 4 %, p = 0.004) compared to patients with no ID/cholestasis. Conclusions ID is common during or after PEG-IFN/RBV therapy for recurrent hepatitis C and frequently associated with decreased graft survival, trending toward low rates of SVR. Careful monitoring of liver biochemistries during or after PEG-IFN/RBV therapy with a low threshold to biopsy patients and particularly those receiving cyclosporine-based immunosuppression may improve outcomes in these patients.

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Section: Introductionmentioning

confidence: 99%

“…Most investigators have instead focused on the treatment of established recurrent HCV after the first 6 months of LT with ≥stage 2 fibrosis [6, 7]. Nevertheless, SVR rates remain low, ranging from 25 to 48 % [7–10].…”

Section: Introductionmentioning

confidence: 99%

Immunological dysfunction during or after antiviral therapy for recurrent hepatitis C reduces graft survival

et al. 2013

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“…Unfortunately, liver transplantation does not cure HCV-infected recipients, but reinfection of HCV universally occurs and disease progression is accelerated compared with that in the nontransplant population, resulting in poor outcomes for HCV-infected recipients. Although several studies have investigated the factors affecting the natural history of recurrent HCV, many aspects remain unclear and require further investigation [4]. For patients with progressive fibrosis, it is essential to monitor disease progression and the only strategy that is known to modify the outcome is antiviral therapy at an appropriate disease stage.…”

Section: Introductionmentioning

confidence: 99%

Liver Transplantation and Hepatitis C

Akamatsu

Sugawara

2012

International Journal of Hepatology

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Hepatitis-C-virus- (HCV-) related end-stage cirrhosis is the primary indication for liver transplantation in many countries. Unfortunately, however, HCV is not eliminated by transplantation and graft reinfection is universal, resulting in fibrosis, cirrhosis, and finally graft decompensation. The use of poor quality organs, particularly from older donors, has a highly negative impact on the severity of recurrence and patient/graft survival. Although immunosuppressive regimens have a considerable impact on the outcome, the optimal regimen after liver transplantation for HCV-infected patients remains unclear. Disease progression monitoring with protocol biopsy and new noninvasive methods is essential for predicting patient/graft outcome and starting antiviral treatment with the appropriate timing. Antiviral treatment with pegylated interferon and ribavirin is currently considered the most promising regimen with a sustained viral response rate of around 30% to 35%, although the survival benefit of this regimen remains to be investigated. Living-donor liver transplantation is now widely accepted as an established treatment for HCV cirrhosis and the results are equivalent to those of deceased donor liver transplantation.

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“…Most side effects are of hematologic (anaemia, neutropenia, thrombocyotpenia), or psychiatric nature (depression). In addition, rejection and ''de novo autoimmune hepatitis'' can be triggered by the use of interferon [1,2].…”

mentioning

confidence: 99%

“…Treatment with IFN-regimes was usually considered in patients with F2 or F0-1 and significant inflammation based on protocol graft biopsies ± non-invasive monitoring tools (particularly fibroscan) because results and tolerability were significantly better compared to treating patients with more advanced disease [1][2][3]. Dual therapy with ribavirin (RBV) resulted in sustained viral response (SVR) rates in the range of 25-40% in patients with HCV genotype 1 and 45-65% in non-1 HCV genotypes.…”

mentioning

confidence: 99%