Survival benefits of interferon-based therapy in patients with recurrent hepatitis C after orthotopic liver transplantation

Abstract

Recurrent hepatitis C after orthotopic liver transplantation (OLT) is universal and can lead to graft failure and, consequently, reduced survival. Hepatitis C treatment can be used to prevent these detrimental outcomes. The aim of this study was to describe rates of hepatitis C recurrence and sustained virological response (SVR) to interferon-based treatment after OLT and its relationship to survival and progression of liver disease through retrospective analysis of medical records of 127 patients who underwent OLT due to cirrhosis or hepatocellular carcinoma secondary to chronic hepatitis C between January 2002 and December 2013. Fifty-six patients were diagnosed with recurrent disease, 42 started interferon-based therapy and 37 completed treatment. Demographic, treatment- and outcome-related variables were compared between SVR and non-responders (non-SVR). There was an overall 54.1% SVR rate with interferon-based therapies. SVR was associated with longer follow-up after treatment (median 66.5 vs 37 months for non-SVR, P=0.03) and after OLT (median 105 vs 72 months, P=0.074), and lower rates of disease progression (15 vs 64.7%, P=0.0028) and death (5 vs 35.3%, P=0.033). Regardless of the result of therapy (SVR or non-SVR), there was a significant difference between treated and untreated patients regarding the occurrence of death (P<0.001) and months of survival (P<0.001). Even with suboptimal interferon-based therapies (compared to the new direct-acting antivirals) there is a 54.1% SVR rate to treatment. SVR is associated with improved survival and reduced risks of clinical decompensation, loss of the liver graft and death.

Recurrent hepatitis C treatment with direct acting antivirals – a real life study at a Brazilian liver transplant center

“…Another unique factor involving LT patients is the occurrence of graft rejection. The rates observed in the present study with DAA were dramatically lower than a previous study at the same institution with interferon-based therapy (0 vs 48.6% of patients treated, with 38.9% of the rejection episodes considered to be related to interferon therapy) (32). The only rejection case (2% of the 55 patients included) was diagnosed 12 weeks after EOT.…”

Revolution in the diagnosis and management of hepatitis C virus infection in current era

“…Similarly, Chen et al [ 114 ] concurred that HCV genotype 1 was less likely to achieve SVR than non- genotype 1 infection. Zanaga et al [ 115 ] reported higher SVR with genotype 3 and statistically significant association with SVR on a univariate analysis in post-liver transplant population. A systematic review and a meta-analysis reported pooled SVR12 of 90% with simeprevir (SMV) and SOF combination with or without RBV in recurrent genotype 1 in post liver transplant population.…”