Abstract
BackgroundGiven the limited efficacy and high adverse event rate associated with treatment of recurrent hepatitis C after liver transplantation, an individualized treatment strategy should be considered. The aim of this study was to identify predictors of response to antiviral therapy for hepatitis C after living donor liver transplantation (LDLT) and to study the associated adverse events.MethodsA retrospective chart review was performed on 125 hepatitis C virus (HCV)-positive LDLT recipients who received interferon plus ribavirin and/or peginterferon plus ribavirin therapy at Kyoto University between January 2001 and June 2011.ResultsSerum HCV RNA reached undetectable levels within 48 weeks in 77 (62%) of 125 patients, and these patients were defined as showing virological response (VR). Of 117 patients, 50 (43%) achieved sustained VR (SVR). Predictive factors associated with both VR and SVR by univariate analysis included low pretransplant serum HCV RNA levels, a non-1 HCV genotype, and low pretreatment serum HCV RNA levels. In addition, LDLT from ABO-mismatched donors was significantly associated with VR, and white cell and neutrophil counts before interferon therapy were associated with SVR. Multivariate analysis showed that 2 variables–pretransplant serum HCV RNA level less than 500 kIU/mL and a non-1 HCV genotype–remained in models of both VR and SVR and that an ABO mismatch was associated with VR. No variables with a significant effect on treatment withdrawal were found.ConclusionsVirological response to antiviral therapy in patients with hepatitis C recurring after LDLT can be predicted prior to transplant, based on pretransplant serum HCV-RNA levels and HCV genotype. LDLT from ABO-mismatched donors may contribute to more efficacious interferon therapy.Trial RegistrationUMIN-CTR UMIN000003286
Highlights
Hepatitis C virus (HCV) infection, leading to liver cirrhosis and hepatocellular carcinoma, is the leading indications for liver transplantation in Japan, the United States, and Western Europe
The sustained virological response (SVR) rate to telaprevir basedtherapy in patients who had a previous relapse was more than 80%, while that in patients who had no response to previous treatment was around 30% [24]. These results suggest that patients who show a virological response (VR) to peginterferon plus ribavirin are expected to achieve SVR after telaprevir-based therapy
The aims of this study were, to identify noninvasively obtained regular baseline factors associated with VR, SVR, and treatment withdrawal, in order to elucidate the factors associated purely with response to interferon therapy, to identify the valuables related to final outcomes, and to clarify the factors associated with adverse events
Summary
Hepatitis C virus (HCV) infection, leading to liver cirrhosis and hepatocellular carcinoma, is the leading indications for liver transplantation in Japan, the United States, and Western Europe. The progression of recurrent hepatitis C is often accelerated and, without appropriate antiviral therapy, 10– 25% of patients develop cirrhosis within 5 years after transplantation, resulting in poorer prognoses for HCV-positive recipients than HCV-negative recipients [7]. Its efficacy in liver transplant recipients is limited, with the mean sustained virological response (SVR) rate among patients with recurrent hepatitis C after liver transplantation being only 30% (range, 8– 50%) [10]. Given the limited efficacy and high adverse event rate associated with treatment of recurrent hepatitis C after liver transplantation, an individualized treatment strategy should be considered. The aim of this study was to identify predictors of response to antiviral therapy for hepatitis C after living donor liver transplantation (LDLT) and to study the associated adverse events
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