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.
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-infectedpatients 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-infectedpatients. 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.
Authors: Brett E Fortune; Alvaro Martinez-Camacho; Sarah Kreidler; Jane Gralla; Gregory T Everson Journal: Transpl Int Date: 2015-04-16 Impact factor: 3.782
Authors: V Saxena; M M Manos; H S Yee; L Catalli; E Wayne; R C Murphy; V A Shvachko; M P Pauly; J Chua; A Monto; N A Terrault Journal: Aliment Pharmacol Ther Date: 2014-03-24 Impact factor: 8.171
Authors: Fazal A Danish; Salman S Koul; Fazal R Subhani; Ahmed E Rabbani; Saeeda Yasmin Journal: Saudi J Gastroenterol Date: 2010 Oct-Dec Impact factor: 2.485
Authors: Ruben Ciria; María Pleguezuelo; Shirin Elizabeth Khorsandi; Diego Davila; Abid Suddle; Hector Vilca-Melendez; Sebastian Rufian; Manuel de la Mata; Javier Briceño; Pedro López Cillero; Nigel Heaton Journal: World J Hepatol Date: 2013-05-27