ABSTRACT
Choice of calcineurin inhibitor may be a contributing factor to deteriorating patient and graft survival following liver transplantation for hepatitis C virus (HCV). In our multicenter, open-label LIS2T study, de novo liver transplant patients stratified by HCV status were randomized to cyclosporine or tacrolimus. Follow-up data were obtained in an observational study of 95 patients. Mean follow-up was 34 and 37 months, respectively, for cyclosporine-treated (n = 47) and tacrolimus-treated (n = 48) patients. In patients not receiving antiviral therapy, 22 of 31 given cyclosporine (72%) and 24 of 29 given tacrolimus (83%) had biochemical recurrence of HCV. In 68 patients with at least one biopsy, histological evidence of HCV-related hepatitis was present in 27 of 31 (87%) cyclosporine-treated patients and 37 of 37 (100%) tacrolimus-treated patients (P = .02, chi-square test). Three-year actuarial risk of fibrosis stage 2 was 66% with cyclosporine and 90% with tacrolimus; for fibrosis stage 3 or 4 it was 46% and 80%, respectively. Three graft losses were attributed to HCV recurrence in cyclosporine-treated patients and six in tacrolimus-treated patients. Tacrolimus may be associated with increased risk of histological HCV disease recurrence compared to cyclosporine.
Subject(s)
Cyclosporine/therapeutic use , Hepatitis C/surgery , Liver Transplantation/physiology , Tacrolimus/therapeutic use , Adult , Carcinoma, Hepatocellular/surgery , Female , Follow-Up Studies , Hepatitis C/epidemiology , Humans , Immunosuppressive Agents/therapeutic use , Liver Neoplasms/surgery , Liver Transplantation/immunology , Male , Middle Aged , Recurrence , Risk Factors , Time Factors , Treatment OutcomeABSTRACT
Activities performed by the staff of Edna Manly Health Centre, Kingston, Jamaica were studied (Summary)