Toru Ikegami1, Huanlin Wang2, Tomoharu Yoshizumi3, Takeo Toshima3, Shinichi Aishima2, Takasuke Fukuhara3, Norihiro Furusyo4, Kazuhiro Kotoh5, Shinji Shimoda6, Ken Shirabe3, Yoshihiko Maehara3. 1. Department of Surgery and Science, Graduate School of Medical Science, Kyushu University, 3-1-1, Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan. tikesurg@surg2.med.kyushu-u.ac.jp. 2. Department of Anatomic Pathology, Graduate School of Medical Science, Kyushu University, 3-1-1, Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan. 3. Department of Surgery and Science, Graduate School of Medical Science, Kyushu University, 3-1-1, Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan. 4. General Internal Medicine, Graduate School of Medical Science, Kyushu University, 3-1-1, Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan. 5. Medicine and Bioregulatory Science and Medicine and Biosystemic Science, Graduate School of Medical Science, Kyushu University, 3-1-1, Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan. 6. Medicine and Biosystemic Science, Graduate School of Medical Science, Kyushu University, 3-1-1, Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan.
Abstract
PURPOSE: Interferon-induced graft dysfunction (IGD) is a poorly defined, unrecognized, but potentially serious condition for patients receiving antiviral drugs after liver transplantation for hepatitis C. METHODS: We evaluated the characteristics of 80 patients who received pegylated interferon-based antiviral treatment for hepatitis C after living donor liver transplantation (LDLT). RESULTS: Eight patients experienced IGD either during (n = 6) or after completing (n = 2) antiviral treatment. Pathological diagnosis included acute cellular rejection (ACR, n = 1), plasma cell hepatitis (PCH, n = 2), PCH plus ACR (n = 3), and chronic rejection (CR, n = 2). One patient with CR initially presented with PCH plus ACR and the other presented with ACR; both had apparent cholestasis. The six patients with ACR or PCH without cholestasis were successfully treated by discontinuing antiviral treatment and increasing immunosuppression, including steroids. By contrast, both of the patients with CR and cholestasis experienced graft loss, despite aggressive treatment. Univariate analysis showed that pegylated interferon-α2a-based treatment (75 vs. 26.4 %, p < 0.01) was the only significant factor for IGD, and was associated with decreased 5-year graft survival (93.4 vs. 71.4 %, p = 0.04). CONCLUSIONS: IGD is a serious condition during or even after antiviral treatment for hepatitis C after LDLT. Early recognition, diagnosis, discontinuation of interferon, and introduction of steroid-based treatment may help to save the graft.
PURPOSE: Interferon-induced graft dysfunction (IGD) is a poorly defined, unrecognized, but potentially serious condition for patients receiving antiviral drugs after liver transplantation for hepatitis C. METHODS: We evaluated the characteristics of 80 patients who received pegylated interferon-based antiviral treatment for hepatitis C after living donor liver transplantation (LDLT). RESULTS: Eight patients experienced IGD either during (n = 6) or after completing (n = 2) antiviral treatment. Pathological diagnosis included acute cellular rejection (ACR, n = 1), plasma cell hepatitis (PCH, n = 2), PCH plus ACR (n = 3), and chronic rejection (CR, n = 2). One patient with CR initially presented with PCH plus ACR and the other presented with ACR; both had apparent cholestasis. The six patients with ACR or PCH without cholestasis were successfully treated by discontinuing antiviral treatment and increasing immunosuppression, including steroids. By contrast, both of the patients with CR and cholestasis experienced graft loss, despite aggressive treatment. Univariate analysis showed that pegylated interferon-α2a-based treatment (75 vs. 26.4 %, p < 0.01) was the only significant factor for IGD, and was associated with decreased 5-year graft survival (93.4 vs. 71.4 %, p = 0.04). CONCLUSIONS: IGD is a serious condition during or even after antiviral treatment for hepatitis C after LDLT. Early recognition, diagnosis, discontinuation of interferon, and introduction of steroid-based treatment may help to save the graft.
Authors: S Berardi; F Lodato; A Gramenzi; A D'Errico; M Lenzi; A Bontadini; M C Morelli; M R Tamè; F Piscaglia; M Biselli; C Sama; G Mazzella; A D Pinna; G Grazi; M Bernardi; P Andreone Journal: Gut Date: 2006-06-23 Impact factor: 23.059
Authors: Y Soejima; K Shirabe; A Taketomi; T Yoshizumi; H Uchiyama; T Ikegami; M Ninomiya; N Harada; H Ijichi; Y Maehara Journal: Am J Transplant Date: 2012-03-19 Impact factor: 8.086
Authors: K Washburn; K V Speeg; R Esterl; F Cigarroa; M Pollack; C Tourtellot; P Maxwell; G Halff Journal: Transplantation Date: 2001-11-27 Impact factor: 4.939
Authors: Marina Berenguer; Bruno Roche; Victoria Aguilera; Jean-Charles Duclos-Vallée; Laia Navarro; Angel Rubín; Jose-Antonio Pons; Manuel de la Mata; Martín Prieto; Didier Samuel Journal: Liver Transpl Date: 2013-01 Impact factor: 5.799