Background/Aims
Recurrence of hepatitis C after liver transplantation (LT) is universal and may cause
premature graft loss. We evaluated the efficacy and safety of antiviral therapy in
HCV-infected patients with decompensated cirrhosis awaiting LT.
Methods
Fifty-one patients underwent treatment with peginterferon-alfa-2a and ribavirin. A
control group of 51 untreated individuals awaiting LT were matched by age, Child-Pugh
and MELD scores and time on the waiting list.
Results
Case and control patients were comparable for all relevant variables. Fifteen treated
patients (29%) had undetectable HCV-RNA at the time of transplantation and 10 (20%)
achieved SVR. Early virological response and non-1 genotype were the strongest predictors
of viral clearance. There was a higher incidence of bacterial infections in treated
patients vs controls, particularly in Child-Pugh B-C individuals (17 vs 3 episodes)
(log-rank = 0.0016). Importantly, the incidence of spontaneous bacterial peritonitis (SBP) in
patients who were not receiving norfloxacin prophylaxis (n = 83) was significantly higher in the treated group than in controls (log-rank = 0.01).
Conclusions
Our data demonstrate that antiviral treatment prevents hepatitis C recurrence in 20%
of HCV-infected patients. However, treatment should be recommended with caution in
individuals with poor liver function who do not receive norfloxacin prophylaxis for
SBP, since it increases the risk of bacterial infections.
Abbreviations:
LT (liver transplantation), MELD (Model for End-stage Liver Disease), CCr (creatinine clearance), SB (spontaneous bacteremia), SBP (spontaneous bacterial peritonitis), RVR (rapid virological response), EVR (early virological response), EOT (end of treatment response), SVR (sustained virological response), UTI (urinary tract infection), HE (hepatic encephalopathy), W (Week), HCV (hepatitis C virus), ALT (alanine aminotransferase), BR (biochemical response)Keywords
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Article info
Publication history
Published online: December 29, 2008
Accepted:
November 6,
2008
Received in revised form:
November 5,
2008
Received:
September 10,
2008
Associate Editor: P.-A. ClavienFootnotes
☆X.F. has unrestricted grant support from Schering-Plough and Roche. The authors who have taken part in the research of this paper declared that they did not receive funding from the manufacturers of the drugs involved for this study.
Identification
Copyright
© 2009 European Association for the Study of the Liver. Published by Elsevier Inc. All rights reserved.
