Hepatitis C Treatment Response in Liver Transplant Recipients

Abstract

BackgroundHepatitis C virus (HCV)–related end-stage liver disease is the leading indication for liver transplantation (LT). HCV recurrence after LT is universal leading to accelerated recurrence of cirrhosis. Therapeutic response to currently available regimen is reported lower compared to treatment of HCV in non LT patients.ObjectiveEvaluate the response of HCV treatment in LT recipients.MethodsIt was a retrospective study in which medical records of subjects who underwent liver transplant for HCV related liver disease from September 1991 to August 2009 were reviewed.ResultsOne hundred ninety-five subjects with HCV LT recipients charts were reviewed, 139 were excluded as there were not treated. Fifty-six subjects were treated with pegylated interferon and ribavirin standard dose. Mean age was 60 years, predominantly males (82%). Twenty-eight (50%) were white, 18 (32%) were Hispanic and 10 (18%) were African American. Average body mass index was 28, and genotype (GT) 1 was predominant (84%). Median METAVIR fibrosis score was 2. Overall sustained virological response (SVR) in this cohort was 32%. Hispanics and Whites had similar SVR rates (50%) but none of the African Americans achieved SVR and had 40% relapse rate. There were no deaths in subjects who achieved SVR whereas 4 died in non SVR group.ComplicationsSVR group: one subject underwent re-transplantation due to hepatic artery issues, 6 had acute cellular rejection (ACR) during treatment and one had chronic rejection. Overall, 16% received blood transfusions, 21% required erythropoietin respectively for anemia.ConclusionTable 1Treatment Response According to GenotypeGT-1 (n = 47)GT-2 (n = 2)GT-3 (n = 7)SVR13 (28%)5 (71%)No SVR17 (36%)Relapser14 (30%)1 (50%)2 (29%)Treatment intolerant3 (6%)1 (50%)GT, genotype; SVR, sustained virological response. Open table in a new tab BackgroundHepatitis C virus (HCV)–related end-stage liver disease is the leading indication for liver transplantation (LT). HCV recurrence after LT is universal leading to accelerated recurrence of cirrhosis. Therapeutic response to currently available regimen is reported lower compared to treatment of HCV in non LT patients. Hepatitis C virus (HCV)–related end-stage liver disease is the leading indication for liver transplantation (LT). HCV recurrence after LT is universal leading to accelerated recurrence of cirrhosis. Therapeutic response to currently available regimen is reported lower compared to treatment of HCV in non LT patients. ObjectiveEvaluate the response of HCV treatment in LT recipients. Evaluate the response of HCV treatment in LT recipients. MethodsIt was a retrospective study in which medical records of subjects who underwent liver transplant for HCV related liver disease from September 1991 to August 2009 were reviewed. It was a retrospective study in which medical records of subjects who underwent liver transplant for HCV related liver disease from September 1991 to August 2009 were reviewed. ResultsOne hundred ninety-five subjects with HCV LT recipients charts were reviewed, 139 were excluded as there were not treated. Fifty-six subjects were treated with pegylated interferon and ribavirin standard dose. Mean age was 60 years, predominantly males (82%). Twenty-eight (50%) were white, 18 (32%) were Hispanic and 10 (18%) were African American. Average body mass index was 28, and genotype (GT) 1 was predominant (84%). Median METAVIR fibrosis score was 2. Overall sustained virological response (SVR) in this cohort was 32%. Hispanics and Whites had similar SVR rates (50%) but none of the African Americans achieved SVR and had 40% relapse rate. There were no deaths in subjects who achieved SVR whereas 4 died in non SVR group. One hundred ninety-five subjects with HCV LT recipients charts were reviewed, 139 were excluded as there were not treated. Fifty-six subjects were treated with pegylated interferon and ribavirin standard dose. Mean age was 60 years, predominantly males (82%). Twenty-eight (50%) were white, 18 (32%) were Hispanic and 10 (18%) were African American. Average body mass index was 28, and genotype (GT) 1 was predominant (84%). Median METAVIR fibrosis score was 2. Overall sustained virological response (SVR) in this cohort was 32%. Hispanics and Whites had similar SVR rates (50%) but none of the African Americans achieved SVR and had 40% relapse rate. There were no deaths in subjects who achieved SVR whereas 4 died in non SVR group. ComplicationsSVR group: one subject underwent re-transplantation due to hepatic artery issues, 6 had acute cellular rejection (ACR) during treatment and one had chronic rejection. Overall, 16% received blood transfusions, 21% required erythropoietin respectively for anemia. SVR group: one subject underwent re-transplantation due to hepatic artery issues, 6 had acute cellular rejection (ACR) during treatment and one had chronic rejection. Overall, 16% received blood transfusions, 21% required erythropoietin respectively for anemia. ConclusionTable 1Treatment Response According to GenotypeGT-1 (n = 47)GT-2 (n = 2)GT-3 (n = 7)SVR13 (28%)5 (71%)No SVR17 (36%)Relapser14 (30%)1 (50%)2 (29%)Treatment intolerant3 (6%)1 (50%)GT, genotype; SVR, sustained virological response. Open table in a new tab GT, genotype; SVR, sustained virological response.