ABSTRACT
Recurrent hepatitis C after orthotopic liver transplantation (OLT) is universal and can lead to graft failure and, consequently, reduced survival. Hepatitis C treatment can be used to prevent these detrimental outcomes. The aim of this study was to describe rates of hepatitis C recurrence and sustained virological response (SVR) to interferon-based treatment after OLT and its relationship to survival and progression of liver disease through retrospective analysis of medical records of 127 patients who underwent OLT due to cirrhosis or hepatocellular carcinoma secondary to chronic hepatitis C between January 2002 and December 2013. Fifty-six patients were diagnosed with recurrent disease, 42 started interferon-based therapy and 37 completed treatment. Demographic, treatment- and outcome-related variables were compared between SVR and non-responders (non-SVR). There was an overall 54.1% SVR rate with interferon-based therapies. SVR was associated with longer follow-up after treatment (median 66.5 vs 37 months for non-SVR, P=0.03) and after OLT (median 105 vs 72 months, P=0.074), and lower rates of disease progression (15 vs 64.7%, P=0.0028) and death (5 vs 35.3%, P=0.033). Regardless of the result of therapy (SVR or non-SVR), there was a significant difference between treated and untreated patients regarding the occurrence of death (P<0.001) and months of survival (P<0.001). Even with suboptimal interferon-based therapies (compared to the new direct-acting antivirals) there is a 54.1% SVR rate to treatment. SVR is associated with improved survival and reduced risks of clinical decompensation, loss of the liver graft and death.
Subject(s)
Humans , Male , Adult , Middle Aged , Aged , Antiviral Agents/therapeutic use , Carcinoma, Hepatocellular/surgery , Hepatitis C, Chronic/drug therapy , Interferons/therapeutic use , Liver Cirrhosis/surgery , Liver Neoplasms/surgery , Liver Transplantation , Postoperative Complications/drug therapy , Carcinoma, Hepatocellular/etiology , Disease Progression , Hepatitis C, Chronic/complications , Hepatitis C, Chronic/mortality , Liver Cirrhosis/etiology , Liver Neoplasms/etiology , Liver Transplantation/mortality , Recurrence , Retrospective Studies , Risk Factors , Survival Analysis , Sustained Virologic Response , Treatment OutcomeABSTRACT
Objective To optimize the treatment of chronic hepatitis C recurrence.Methods During May 2008 to May 2012, 50 patients with chronic recurrent hepatitis C were chosen in the infectious department of our hospital.They were divided into two groups with 25 cases in each group.Group A was treated by standard extended treatment scheme,while Group B was treated by standard large dose scheme.The effect was estimated by the observation of sustained virologic response in the two groups (sus-tained virologic response,SVR).Results 32% SVR rate was found in group A and 23% SVR rate was found in Group B.38% re-currence rate appeared in group A after six months and 43% recurrence rate occurred in group B,there were significant difference between two groups(P <0.05).Conclusion The standard extended treatment schemes of pegylated interferon and ribavirin is su-perior to group B in SVR rate.
ABSTRACT
A 60-year-old woman with end stage liver cirrhosis caused by genotype 2 hepatitis C virus (HCV) infection received an orthotopic liver transplantation (OLT). The patient was negative for the hepatitis B surface antigen (HBsAg) and positive for the anti-hepatitis B surface antibody (anti-HBs) prior to and one and a half months following the OLT. Due to reactivation of hepatitis C, treatment with interferon-alpha and Ribavirin started two months following the OLT and resulted in a sustained virological response. We performed a liver biopsy because a biochemical response was not achieved. Surprisingly, liver pathology showed HBsAg-positive hepatocytes with a lobular hepatitis feature, which had been negative in the liver biopsy specimen obtained one and a half months post-OLT. High titers of both HBsAg and HBeAg were detected, while anti-HBs antibodies were not found. Tests for IgM anti-hepatitis B core antibody and anti-delta virus antibodies were negative. The serum HBV DNA titer was over 1x10(7) copies/mL. A sequencing analysis showed no mutation in the "a" determinant region, but revealed a mixture of wild and mutant strains at an overlapping region of the S and P genes (S codon 213 (Leu/Ile); P codons 221 (Phe/Tyr) and 222 (Ala/Thr)). These findings suggest that de novo hepatitis B can develop in patients with HCV infection during the post-OLT period despite the presence of protective anti-HBs.