Post-transplant treatment with pegylated interferon alpha-2a and ribavirin achieved SVR in 56% of liver transplant recipients with chronic HCV genotype 4 infection. The combination was relatively safe and exhibited a low rate of treatment withdrawal.

The laparoscopic assessment of donors in LDLT is a safe and acceptable procedure that avoids unnecessary large abdominal incisions and increases the chance of achieving donor safety.

BACKGROUND AND OBJECTIVES:There are few reports on hepatitis C virus genotype 4 (HCV-4) recurrences after orthotopic liver transplantation (OLT). Therefore, we undertook a study to determine the epidemiological, clinical and virological characteristics of patients with biopsy-proven recurrent HCV infection and analyzed the factors that influence recurrent disease severity. We also compared disease recurrence and outcomes between HCV-4 and other genotypes.PATIENTS AND METHODS:All patients who underwent OLT (locally or abroad) for HCV related hepatic cirrhosis from 1991 to 2006 and had recurrent HCV infection were identified. Clinical, laboratory and pathological data before and after OLT were collected and analyzed.RESULTS:Of 116 patients who underwent OLT for hepatitis C, 46 (39.7%) patients satisfied the criteria of recurrent hepatitis C. Twenty-nine (63%) patients were infected with HCV genotype 4. Mean (SD) for age was 54.9 (10.9) years. Nineteen of the HCV genotype 4 patients (65.5%) were males, 21 (72.4%) received deceased donor grafts, and 7 (24.1%) developed ≥1 acute rejection episodes. Pathologically, 7 (24.1%) and 4 (13.8%) patients had inflammation grade 3-4 and fibrosis stage 3-4, respectively. Follow-up biopsy in 9 (31%) HCV genotype 4 patients showed stable, worse and improved fibrosis stage in 5, 2 and 2 patients, respectively. Of the 7 patients in the recurrent HCV group who died, 6 were infected with genotype 4 and 4 of them died of HCV-related disease.CONCLUSION:This analysis suggests that HCV recurrence following OLT in HCV-4 patients is not significantly different from its recurrence for other genotypes.

No abstract

Recurrent hepatitis C is characterized by a higher rate of fibrosis progression and in almost 30% of the cases lead to graft cirrhosis within 5 years Goal: 1) to investigate the rate of severe HCV recurrence after OLT based in protocol liver biopsies and 2) to investigate decompensation, retrasplantation, and survival rates after severe HCV recurrence Methods: The study included 88 patients (pts) who underwent OLT between 6/95 and 12/09. Inclusion criteria were: recurrent HCV infection after OLT (detectable HCV RNA in serum), follow up ≥ 1 year and annual protocol liver biopsies. Severe recurrence of HCV was defined as fibrosis stage ≥ to F3 in protocol biopsies performed at any time after OLT. Pts with fibrosing cholestatic hepatitis were excluded. Staging of recurrent hepatitis C was assessed with the METAVIR score. Actuarial risk analysis was investigated by Kaplan-Meier Results: based on protocol biopsies HCV recurrence was diagnosed as mild in 60 (68%) and severe in 28 (32%) pts. Mean number of biopsies analyzed were 6±2 biopsies per pts. Actuarial Risk at 1,3 and 5 yrs post OLT for fibrosis stage F3 was 8%, 27%, 32% and for F4 0%, 11% and 23% at the same time periods. Mean time interval between OLT and F3-F4 stage fibrosis was 37±26 months. 36% (10/28) of the pts with severe recurrence experienced decompentation, developing ascitis (100%), spontaneous bacterial peritonitis (30%) and encephalopathy (50%).40% developed esophageal varices, with 3 episodes of varices bleeding. Median time interval from last biopsies to decompensation was 30 (1-98) months. 50% of the pts required re transplantation and pts actuarial survival rate at 1,2,3 yrs were 100%, 71%, 47%. In pts with severe recurrence without decompensation (64%) actuarial survival rate at 1,2,3 years were 100%, 97% and 95% (P=0,0002). Conclusions: 1) Natural history of hepatitis C in inmunossupressed liver transplant recipients is characterized by an accelerated fibrogenesis 2) After 5 years of follow up the actuarial risk of reaching stage 3 fibrosis was 32% and of developing cirrhosis 23% 3) Prevalence of decompensation after severe recurrence was 36% with decrease survival overtime, although the higher rate of retransplantation Disclosure: All authors have declared no conflicts of interest.Inroduction:The use of hepatitis B immunoglobulin (HBIg) and lamivudine resulted in a significant reduction in hepatitis B virus (HBV) recurrence following liver transplantation (LT). The aim of this study was (a) to evaluate the use of lamivudine and/or adefovir in combination with long term intravenous HBIg in preventing disease recurrence and (b) to evaluate the HBV serological markers following LT. METHODS: 111 patients who received a liver transplantation for HBV related cirrhosis and were followed in our center from Jan 1990 to December 2009 were included. With the exception of four patients (transplanted prior to 1993) all patients received combination therapy with nucleos(t)ide analogue and HBIg . Breakthrough infection was defined as a re-emergence of HBVD...

Background: Kidney transplant (KT) recipients have a high rate of hepatitis C virus (HCV) infection, which can impact long-term graft and patient survival rates. Although direct-acting antivirals (DAAs) are effective for treating HCV, there is limited data on their use in post-KT patients with HCV genotype 4 infection. Objectives: To evaluate the effectiveness and occurrence of adverse events with grazoprevir/elbasvir combination treatment without ribavirin in post-KT patients with HCV genotype 4 infection. Methods: In this case series, nine therapy-naïve adult post-KT patients with HCV genotype 4 infection were recruited. They had stable graft function and received a fixed dose of grazoprevir/elbasvir (50 mg/100 mg) combination without ribavirin daily for 12 weeks. Patients co-infected with hepatitis B virus, HIV, or with evidence of decompensated liver disease were excluded from the study. Patients were monitored for viral load, laboratory values, and adverse events associated with drug treatment. The response was defined by the sustained virologic response at 12 weeks (SVR12) after the end of treatment. Results: All nine patients completed the treatment period and achieved SVR12 with no treatment failure or relapse. Of them, six patients had HCV genotype 4 infection alone, and three had HCV of mixed genotypes 1 and 4. Two (22%) patients showed a rapid HCV clearance at four weeks. No adverse events or serious adverse events were reported. The patients’ renal function was stable during and after the treatment with no deterioration of graft function, and no adjustments to the immunosuppressive therapy were required. Conclusions: Grazoprevir/elbasvir combination without ribavirin is an effective and safe treatment option for post-KT patients with genotype 4 HCV infection.

Background: Interleukins are a group of cytokines (secreted proteins/signaling molecules) that were first seen to be expressed by white blood cells (leukocytes). In chronic hepatitis C, intra-hepatic expression of both IL-8 and IL-2 increased with fibrosis and inflammatory activity. Positive correlations were found between IL-8 and other cytokines and between cytokines themselves. These findings suggest that these interacting cytokines play an active role in the pathogenesis of CHC, and maybe involved in the up regulation or induction of one and other, and interleukin-6 (IL-6), the major cytokine inducers of the acute phase response, are markedly raised in acute alcoholic hepatitis and correlate closely with clinical and laboratory indicators of disease severity. Methods: We measured (IL-2, IL-4, IL-6 and IL-8) serum levels in 60 patients classified into three different groups twenty chronic renal failure patients, twenty liver disease patients and twenty patients of chronic renal failure combined with liver diseases in comparison to twenty healthy controls. Serum (IL-2, IL-4, IL-6 and IL-8) were determined using ELISA technique. Results: IL-2 and IL-6 were significantly highest in HCV and combined groups with no significant difference between them, followed by renal group compared to IL-4 and IL-8 were significantly highest in combined group, followed by renal group, followed by HCV group and lowest in control group. Conclusions: IL-2 and IL-6 are elevated in patients with chronic HCV disease. IL-4 and IL-8 are elevated in chronic renal failure.

No abstract