Antiviral prophylactic intervention for chronic hepatitis C virus in patients undergoing liver transplantation

Gurusamy, Kurinchi; Tsochatzis, Emmanuel; Davidson, Brian R; Burroughs, Andrew K.

doi:10.1002/14651858.cd006573.pub2

Cited by 16 publications

(13 citation statements)

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“…HCV antibody therapy starts in the anhepatic phase and then is continued for 12 to 14 wk after transplant. Three trials [110][111][112] comparing high dose HCV antibody vs. low dose HCV antibody were included in a Cochrane meta-analysis [113] . There was no difference in patient and graft survival, virological response or fibrosis on histology.…”

Section: Post-transplant Antiviral Treatmentmentioning

confidence: 99%

Strategies to reduce hepatitis C virus recurrence after liver transplantation

Ciria

Pleguezuelo²,

Khorsandi³

et al. 2013

WJH

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Hepatitis C virus (HCV) is a major health problem that leads to chronic hepatitis, cirrhosis and hepatocellular carcinoma, being the most frequent indication for liver transplantation in several countries. Unfortunately, HCV re-infects the liver graft almost invariably following reperfusion, with an accelerated history of recurrence, leading to 10%-30% of patients progressing to cirrhosis within 5 years of transplantation. In this sense, some groups have even advocated for not retransplanting this patients, as lower patient and graft outcomes have been reported. However, the management of HCV recurrence is being optimized and several strategies to reduce post-transplant recurrence could improve outcomes, decrease the rate of re-transplantation and optimize the use of available grafts. Three moments may be the focus of potential actions in order to decrease the impact of viral recurrence: the pretransplant moment, the transplant environment and the post-transplant management. In the pre-transplant setting, it is not well established if reducing the pre transplant viral load affects the risk for HCV progression after transplant. Obviously, antiviral treatment can render the patient HCV RNA negative post transplant but the long-term benefit has not yet been fully established to justify the cost and clinical risk. In the transplant moment, factors as donor age, cold ischemia time, graft steatosis and ischemia/reperfusion injury may lead to a higher and more aggressive viral recurrence. After the transplant, discussion about immunosuppression and the moment to start the treatment (prophylactic, pre-emptive or once-confirmed) together with new antiviral drugs are of interest. This review aims to help clinicians have a global overview of posttransplant HCV recurrence and strategies to reduce its impact on our patients.

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Section: Post-transplant Antiviral Treatmentmentioning

confidence: 99%

Strategies to reduce hepatitis C virus recurrence after liver transplantation

Ciria

Pleguezuelo²,

Khorsandi³

et al. 2013

WJH

View full text Add to dashboard Cite

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“…Therefore, the results were also very different, with SVR rates ranging 0% to 56% (median: 33%), discontinuation rates ranging 4% to 58%, and dose reduction rate ranging 28% to 100%. In addition, the survival benefit of the treatment has not been confirmed in most studies so far, and it is compelling to conclude that there is currently no evidence to support the antiviral treatment for recurrent graft hepatitis C due to the lack of clinical benefit and frequent adverse effects, as concluded by the recent Cochrane meta-analysis [191]. On the other hand, recent retrospective cohort studies with a considerable follow-up duration found improved patient/graft survival in patients who obtained an SVR after antiviral treatment [35, 192–194].…”

Section: Antiviral Treatmentmentioning

confidence: 99%

Living-Donor Liver Transplantation and Hepatitis C

Akamatsu

Sugawara

2013

HPB Surgery

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Hepatitis-C-virus- (HCV-) related end-stage cirrhosis is the primary indication for liver transplantation in many countries. Unfortunately, however, HCV is not eliminated by transplantation and graft reinfection is universal, resulting in fibrosis, cirrhosis, and finally graft decompression. In areas with low deceased-donor organ availability like Japan, living-donor liver transplantation (LDLT) is similarly indicated for HCV cirrhosis as deceased-donor liver transplantation (DDLT) in Western countries and accepted as an established treatment for HCV-cirrhosis, and the results are equivalent to those of DDLT. To prevent graft failure due to recurrent hepatitis C, antiviral treatment with pegylated-interferon and ribavirin is currently considered the most promising regimen with a sustained viral response rate of around 30% to 35%, although the survival benefit of this regimen remains to be investigated. In contrast to DDLT, many Japanese LDLT centers have reported modified treatment regimens as best efforts to secure first graft, such as aggressive preemptive antiviral treatment, escalation of dosages, and elongation of treatment duration.

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“…The rate of recurrence of HBV fell dramatically because of the introduction of human HBV immunoglobulins and nucleoside analogs 9. Although some antiviral agents, such as ribavirin or interferon, have been used as prophylactic therapy to prevent HCV infection in liver grafts, it is not clear whether these agents are of any benefit to patients 10,11. The response to antiviral therapies may contribute to the causal difference in late allograft dysfunction between the HBV and HCV.…”

Section: Discussionmentioning

confidence: 99%

Histopathological Causes of Late Liver Allograft Dysfunction: Analysis at a Single Institution

Shin

Kim

2013

Korean J Pathol

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BackgroundWe summarize our experience in the pathological diagnosis of late complications of liver transplantation (LT) to better understand the causes of late allograft dysfunction in a population mostly composed of patients with hepatitis B virus (HBV) infection.MethodsWe reviewed 361 post-transplant liver biopsies from 174 patients who underwent LT and first presented with liver function abnormalities 3 months post-procedure. The underlying diseases included HBV-associated liver disease (77%), toxic or alcoholic liver disease (10.3%), hepatitis C virus (HCV)-associated liver disease (8.6%), primary biliary cirrhosis (1.2%), primary sclerosing cholangitis (1.2%), and metabolic disease (1.7%).ResultsThe three most common late complications were acute rejection (32.5%), recurrent disease (19.1%), and biliary complication (17.1%). Patients who underwent LT for HBV infection or for drug- or alcohol-related liver disease had a lower incidence of recurring disease than those who underwent transplantation for HCV infection. During post-transplantation months 3-12, acute rejection was the most common cause of allograft dysfunction and recurring disease was the leading cause for allograft dysfunction (p=0.039). The two primary causes of late allograft dysfunction have overlapping histological features, although acute rejection more frequently showed bile duct damage and vascular endothelialitis than recurring HBV infection, and recurring HBV infection had more frequent lobular activity and piecemeal necrosis.ConclusionsThe causes of late liver allograft dysfunction are closely associated with the original liver diseases and the period after LT. Careful attention is required for differential diagnosis between acute rejection and recurrent HBV.

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Antiviral prophylactic intervention for chronic hepatitis C virus in patients undergoing liver transplantation

Cited by 16 publications

References 50 publications

Strategies to reduce hepatitis C virus recurrence after liver transplantation

Strategies to reduce hepatitis C virus recurrence after liver transplantation

Living-Donor Liver Transplantation and Hepatitis C

Histopathological Causes of Late Liver Allograft Dysfunction: Analysis at a Single Institution

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