Fibrosing cholestatic hepatitis C in post-transplant adult recipients of liver transplantation

Hori, Tomohide; Onishi, Yuki; Kamei, Hideya; Kurata, Nori; Ishigami, Masatoshi; Ishizu, Yoji; Ogura, Yasuhiro

doi:10.20524/aog.2016.0069

Cited by 17 publications

(13 citation statements)

References 56 publications

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“…Depending on regional variation, access to organs, and center-specific practice patterns, the decision to treat HCV+ recipients on the waiting list continues to be a complex topic; that being said, we saw no detriment to treating pre-LT patients at our institution. Finally, HCV eradication pre-LT should completely prevent the devastating complication of FCH, which has been reported in up to 10% of HCV+ LT recipients and was the observed rate in the present study [24]. This should provide a cost-savings to the healthcare system, as these patients often suffer from prolonged hospitalizations.…”

Section: Discussionsupporting

confidence: 56%

HCV Eradication with Direct-Acting Antivirals Does Not Impact HCC Progression on the Waiting List or HCC Recurrence after Liver Transplantation

Emamaullee

Bral

Meeberg

et al. 2019

Canadian Journal of Gastroenterology and Hepatology

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Background The introduction of direct-acting antivirals (DAA) for HCV has led to high rates of HCV eradication. Treatment of patients awaiting liver transplantation (LT) has been controversial. Recent data suggests that DAA treatment may accelerate recurrent HCC. The impact of DAA on delisting for HCC progression or recurrent HCC post-LT has not been well characterized. Methods A retrospective review of both waitlist patients and LT recipients at a single institution was performed. Patient demographics, HCV treatment, HCC features and treatments, biopsy results, and graft and patient survival were evaluated. Patients on the LT waitlist or who were transplanted between January 2014 and December 2015 were included. Data was collected through December 2017 to have a minimum of two years of follow-up. Results In the study period, 128 adult LT were performed. 44 patients were HCV+, and 68.2% (N=30) also had HCC. 38.6% (N=17) of HCV+ patients received DAA pre-LT, and 94.1% (N=16/17) achieved sustained virologic response (SVR) pre-LT. Among untreated HCV+ patients who underwent LT, 81.5% (N=22/27) received DAA post-LT, with 82.6% achieving SVR post-LT (N=18/22). 82.1% (N=23/28) of untreated post-LT patients underwent liver biopsy prior to therapy, and 52.2% had at least F1 METAVIR fibrosis. 87.5% (N=14/16) of active waitlist patients received DAA and achieved SVR. HCV eradication did not result in higher rates of delisting for HCC progression. Due to local HCC listing criteria of total tumor volume and AFP, 60% (N=18/30) of HCV+/HCC patients were beyond Milan criteria at the time of LT. Despite this, there was no difference in HCC recurrence rates post-LT, whether patients achieved SVR pre- or post-LT. Conclusions These data suggest that HCV eradication pre-LT does not significantly impact waitlist time for HCV+ patients with HCC. HCV eradication does not impact rates of delisting for HCC progression or rates of HCC recurrence post-LT.

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Section: Discussionsupporting

confidence: 56%

HCV Eradication with Direct-Acting Antivirals Does Not Impact HCC Progression on the Waiting List or HCC Recurrence after Liver Transplantation

Emamaullee

Bral

Meeberg

et al. 2019

Canadian Journal of Gastroenterology and Hepatology

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“…If treatment is delayed beyond the early posttransplantation period, protocols that monitor for infection, new‐onset diabetes mellitus, glomerulonephritis, and severe cholestatic hepatitis should be put in place . Severe cholestatic hepatitis is a feared complication occurring in up to 10% of liver and 1.5% of kidney recipients and is associated with high mortality . Compassionate‐use data for sofosbuvir and other DAA therapy in the setting of severe cholestatic hepatitis have reported high sustained virologic response rates (SVRs) and reversal of liver decompensation .…”

Section: Transmission and Treatment Concernsmentioning

confidence: 99%

The American Society of Transplantation Consensus Conference on the Use of Hepatitis C Viremic Donors in Solid Organ Transplantation

Levitsky¹,

Formica

Bloom

et al. 2017

American Journal of Transplantation

291

342

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The availability of direct-acting antiviral agents for the treatment of hepatitis C virus (HCV) infection has resulted in a profound shift in the approach to the management of this infection. These changes have affected the practice of solid organ transplantation by altering the framework by which patients with end-stage organ disease are managed and receive organ transplants. The high level of safety and efficacy of these medications in patients with chronic HCV infection provides the opportunity to explore their use in the setting of transplanting organs from HCV-viremic patients into non-HCV-viremic recipients. Because these organs are frequently discarded and typically come from younger donors, this approach has the potential to save lives on the solid organ transplant waitlist. Therefore, an urgent need exists for prospective research protocols that study the risk versus benefit of using organs for hepatitis C-infected donors. In response to this rapidly changing practice and the need for scientific study and consensus, the American Society of Transplantation convened a meeting of experts to review current data and develop the framework for the study of using HCV viremic organs in solid organ transplantation.

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“…Despite advances in low-toxicity immunosuppressive drugs, the long-term success of liver transplantation is still limited by the development of chronic liver allograft dysfunction (Starzl et al, 1985). Many studies have emphasized improving the liver transplantation surgery procedure and instituting personalized management of post-transplant patients, including minimization strategies for transplant immunosuppression, to decrease the development of unpredictable clinical complications such as acute and chronic rejection (Reyes et al, 2000), de novo autoimmunity (Fedoseyeva et al, 1999), fibrosing cholestatic hepatitis (Hori et al, 2016), infections, and chronic dysfunction (Kok et al, 2017). Additionally, underlying chronic illnesses such as hypertension, diabetes, dyslipidemia, and graft impairment all have severe impacts on the recovery of liver function, thus affecting longevity and quality of life of post-transplant patients (Schoening et al, 2013).…”

Section: Introductionmentioning

confidence: 99%

Fecal Microbiome Data Distinguish Liver Recipients With Normal and Abnormal Liver Function From Healthy Controls

Lü

Ren

et al. 2019

Front. Microbiol.

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Emerging evidence suggests that altered intestinal microbiota plays an important role in the pathogenesis of many liver diseases, mainly by promoting inflammation via the “intestinal microbiota-immunity-liver” axis. We aimed to investigate the fecal microbiome of liver recipients with abnormal/normal liver function using 16S rRNA gene sequencing. Fecal samples were collected from 90 liver recipients [42 with abnormal liver function (Group LT_A) and 48 with normal liver function (Group LT_N)] and 61 age- and gender-matched healthy controls (HCs). Fecal microbiomes were analyzed for comparative composition, diversity, and richness of microbial communities. Principal coordinates analysis successfully distinguished the fecal microbiomes of recipients in Group LT_A from healthy subjects, with the significant decrease of fecal microbiome diversity in recipients in Group LT_A. Other than a higher relative abundance of opportunistic pathogens such as Klebsiella and Escherichia / Shigella in all liver recipients, the main difference in gut microbiome composition between liver recipients and HC was the lower relative abundance of beneficial butyrate-producing bacteria in the recipients. Importantly, we established a fecal microbiome index (specific alterations in Staphylococcus and Prevotella ) that could be used to distinguish Group LT_A from Group LT_N, with an area under the receiver operating characteristic curve value of 0.801 and sensitivity and specificity values of 0.771 and 0.786, respectively. These findings revealed unique gut microbial characteristics of liver recipients with abnormal and normal liver functions, and identified fecal microbial risk indicators of abnormal liver function in liver recipients.

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Fibrosing cholestatic hepatitis C in post-transplant adult recipients of liver transplantation

Cited by 17 publications

References 56 publications

HCV Eradication with Direct-Acting Antivirals Does Not Impact HCC Progression on the Waiting List or HCC Recurrence after Liver Transplantation

HCV Eradication with Direct-Acting Antivirals Does Not Impact HCC Progression on the Waiting List or HCC Recurrence after Liver Transplantation

The American Society of Transplantation Consensus Conference on the Use of Hepatitis C Viremic Donors in Solid Organ Transplantation

Fecal Microbiome Data Distinguish Liver Recipients With Normal and Abnormal Liver Function From Healthy Controls

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