Early development of chronic active hepatitis in recurrent hepatitis C virus infection after liver transplantation: association with treatment of rejection

Berenguer, Marina; Prieto, M.; Córdoba, Juan; Rayón, José M.; Carrasco, Domingo; Olaso, V.; Sanjuán, F.; Gobernado, M; Mir, José; Berenguer, J

doi:10.1016/s0168-8278(98)80224-9

Cited by 166 publications

(115 citation statements)

References 23 publications

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“…However, given that bolus steroids seem to enhance fibrosis progression in patients with recurrent HCV, it would seem prudent to perform liver biopsy in all patients with a marked acute increase in serum liver chemistries rather than offer empiric treatment for rejection. [36][37][38][39] …”

Section: Acute Recurrence Of Hepatitis C Infectionmentioning

confidence: 99%

“…[19][20][21][22][23][24] During this same time interval, several retrospective studies suggested that the use of monoclonal antibody preparations, multiple steroid boluses for treatment of acute rejection, and the development of steroid-resistant rejection enhanced the histologic severity of recurrent HCV. [14][15][16][37][38][39]41 These observations led to the hypothesis that excessive immunosuppression was deleterious for HCV and a philosophy in which less global immunosuppression was used for patients with chronic HCV infection. As a result, monoclonal antibody preparations were avoided and the rapid tapering and early discontinuation of corticosteroids after transplantation was instituted.…”

Section: Effect Of Immunosuppressionmentioning

confidence: 99%

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Controversies in the management of hepatitis C virus infection after liver transplantation

Shiffman¹,

Vargas²,

Everson³

2003

Liver Transplantation

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Recurrence of hepatitis C virus infection after liver transplantation is universal. A significant percentage of these patients develop progressive graft injury and cirrhosis. Those factors that modulate disease progression in liver transplant recipients with recurrent hepatitis C virus infection remain controversial and are poorly understood. Treatment of recurrent hepatitis C virus after liver transplantation with either interferon or interferon and ribavirin has yielded only limited success. Regardless of this, treatment is instituted. Peginterferon is more effective than standard interferon for treatment of chronic hepatitis C virus infection in the nontransplantation setting when used either alone or with ribavirin. The effectiveness of peginterferon, both with and without ribavirin in the posttransplantation setting, is currently being explored. In this review those factors thought to affect disease progression in patients with recurrent hepatitis C virus will be discussed, strategies that have been used to treat recurrent hepatitis C virus will be reviewed, and the impact that peginterferon may have on hepatitis C virus infection in the pretransplantation and posttransplantation setting will be explored. C irrhosis secondary to chronic infection with the hepatitis C virus (HCV) is the leading indication for liver transplantation. 1,2 Although transplantation is an effective treatment for end-stage liver disease secondary to chronic HCV infection, virus recurs in essentially all patients. 1-3 Progressive graft injury leading to cirrhosis occurs in about 25% to 33% of patients within just 5 years. [4][5][6][7][8] In addition, a limited group of patients (about 1% to 5% of recipients) develop rapidly progressive cholestatic hepatitis and liver failure within just 1 to 2 years. [8][9][10][11] Numerous studies have attempted to identify those factors that affect disease progression in these patients. Unfortunately, nearly all studies in this area have been retrospective in nature, conducted in patient populations of limited size, at single centers, utilized an array of immune suppressive medications in an uncontrolled manner, and have failed to consistently utilize protocol liver biopsy to investigate histologic progression. In addition, allograft rejection has not been either universally defined or treated and assays to measure serum HCV RNA have varied between centers and changed over time. As a result, data from many studies seem to contradict each other and the interpretation of these findings has varied widely. It is therefore not surprising how little progress has been made in our understanding of recurrent HCV over the past decade and that no universally accepted algorithm for managing these patients has emerged.Interferon (IFN) alfa with or without ribavirin (RBV) is the treatment of choice for patients with chronic HCV infection. 12,13 These medications have also been used to treat recurrent HCV after liver transplantation, but the interpretation of these data has been plagued by a similar set of limit...

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Section: Acute Recurrence Of Hepatitis C Infectionmentioning

confidence: 99%

Section: Effect Of Immunosuppressionmentioning

confidence: 99%

Controversies in the management of hepatitis C virus infection after liver transplantation

Shiffman¹,

Vargas²,

Everson³

2003

Liver Transplantation

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“…Interestingly, a few studies have noted that MELD scores (which include serum creatinine and serum bilirubin) do not accurately predict posttransplantation survival. 35,36 MELD scores did accurately More rejection 6,11,18 Donor age 4 Year of transplantation 5,20 Peak asparate aminotransferase level 21 Cytomegalovirus viremia 22 Human leukocyte antigen compatibility 24,25 Nonwhite race 5 Prolonged rewarming 23 OKT-3 use 19 37 The UCLA model, used in both primary and retransplantation, uses pretransplantation variables readily available to physicians. The model found that predicted posttransplantation survival and Kaplan-Meier survival were similar.…”

Section: Patient Variables and Models For Predicting Patient Survivalmentioning

confidence: 99%

Retransplantation for recurrent hepatitis C: Positive aspects

McCashland¹

2003

Liver Transplantation

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“…Important information is obtained from the liver biopsy which helps determine management strategies. This becomes particularly important in patients who have hepatitis C as their underlying liver disease, because rejection has been shown to have a major deleterious effect on the long-term course of recurrent hepatitis C. 11,12 Chronic rejection, on the other hand, has been decreasing over the past decade, with most transplant centers reporting less than a 4% incidence of this serious complication. 13,14 The reason for the decrease in …”

Section: Rejectionmentioning

confidence: 99%

Late hepatic allograft dysfunction

Wiesner

2001

Liver Transplantation

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Key Points1. Lifelong monitoring of graft function, immunosuppressive levels, and screening for drug toxicity is required in all liver recipients.2. Late hepatic allograft dysfunction is common and is caused by a variety of etiologies including rejection, infection, biliary/vascular abnormalities, recurrence of disease, and drug hepatotoxicity.3. In all patients with late hepatic allograft dysfunction, liver biopsy should be performed to assess for the presence of rejection, and to thus avoid excessive use of bolus corticosteroid therapy and guide appropriate immunosuppressive management.4. Recurrence of disease is the most common cause of late hepatic allograft dysfunction.5. Hepatitis C universally reinfects the hepatic allograft, and is associated with decreased patient and graft survival and leads to the recurrence of cirrhosis in 28% of patients within 5 years of transplantation.

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Early development of chronic active hepatitis in recurrent hepatitis C virus infection after liver transplantation: association with treatment of rejection

Cited by 166 publications

References 23 publications

Controversies in the management of hepatitis C virus infection after liver transplantation

Controversies in the management of hepatitis C virus infection after liver transplantation

Retransplantation for recurrent hepatitis C: Positive aspects

Late hepatic allograft dysfunction

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