Long-term maintenance of sustained virological response in liver transplant recipients treated for recurrent hepatitis C

Ponziani, Francesca Romana; Viganò, R.; Iemmolo, R.M.; Donato, Maria Francesca; Rendina, Maria; Toniutto, Pierluigi; Pasulo, L.; Burra, Patrizia; Miglioresi, L.; Merli, Manuela; Paolo, D. Di; Fagiuoli, Stefano; Gasbarrini, Antonio; Pompili, Maurizio; Belli, Luca; Gerunda, G.E.; Marino, M.; Montalti, Roberto; Benedetto, Fabrizio Di; Ruvo, N. De; Rigamonti, Cristina; Colombo, Massimo; Rossi, G.; Leo, Alfredo Di; Lupo, L.; Memeo, V.; Bringiotti, R.; Zappimbulso, M.; Bitetto, Davide; Vero, Vittoria; Colpani, M.; Fornasiere, Ezio; Pinna, Antonio D.; Morelli, Maria Cristina; Bertuzzo, Valentina Rosa; Martin, Eléonora De; Senzolo, Marco; Ettorre, Giuseppe Maria; Visco-Comandini, Ubaldo; Antonucci, Giorgio; Angélico, M.; Tisone, Giuseppe; Giannelli, V.; Giusto, M.

doi:10.1016/j.dld.2014.01.157

Cited by 3 publications

(4 citation statements)

References 38 publications

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“…Baseline characteristics and outcomes of FCH and non-FCH patients are presented in Among 52 cirrhotics, the SVR12 rate was 66%. Also in this subgroup all relapsers were successfully re-treated and experienced an improvement of baseline vs long-term observation MELD (13 [11][12][13][14][15][16][17][18] vs 9 [7][8][9][10][11][12][13], P<.0001) and CTP score (9 [7-10] vs 5 [5,6], P<.0001).…”

Section: Outcomes In Patients With Fch and In Cirrhoticsmentioning

confidence: 87%

“…All liver function tests improved significantly during and after therapy. The MELD score was improved from baseline to last follow-up (15 [11][12][13][14][15][16][17][18][19] vs 10 [7][8][9][10][11][12][13], P<.0001, Fig. S1A).…”

Section: Clinical Outcomesmentioning

confidence: 96%

“…[6][7][8][9] Successful antiviral therapy of HCV recurrence has been shown to allow longer survival and better clinical outcome. 10 In recent years, therapeutic management of HCV recurrence has changed [11][12][13] with excellent virological results of direct acting antivirals (DAAs). [14][15][16][17][18][19][20][21][22] Nevertheless, data on their long-term outcomes are lacking in the actual literature.…”

Section: Introductionmentioning

confidence: 99%

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Long‐term outcomes of direct acting antivirals in post‐transplant advanced hepatitis C virus recurrence and fibrosing cholestatic hepatitis

Vukotic¹,

Conti²,

Fagiuoli

et al. 2017

Journal of Viral Hepatitis

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Long-term functional outcomes of sofosbuvir-based antiviral treatment were evaluated in a cohort study involving 16 Italian centres within the international compassionate use programme for post-transplant hepatitis C virus (HCV) recurrence. Seventy-three patients with cirrhosis (n=52) or fibrosing cholestatic hepatitis (FCH, n=21) received 24-week sofosbuvir with ribavirin±pegylated interferon or interferon-free sofosbuvir-based regimen with daclatasvir/simeprevir+ribavirin. The patients were observed for a median time of 103 (82-112) weeks. Twelve of 73 (16.4%) died (10 non-FCH, 2 FCH) and two underwent re-LT. Sustained virological response was achieved in 46 of 66 (69.7%): 31 of 47 (66%) non-FCH and 15 of 19 (79%) FCH patients. All relapsers were successfully retreated. Comparing the data of baseline with last follow-up, MELD and Child-Turcotte-Pugh scores improved both in non-FCH (15.3±6.5 vs 10.5±3.8, P<.0001 and 8.4±2.1 vs 5.7±1.3, P<.0001, respectively) and FCH (17.3±5.9 vs 10.1±2.8, P=.001 and 8.2±1.6 vs 5.5±1, P=.001, respectively). Short-treatment mortality was higher in patients with baseline MELD≥25 than in those with MELD<25 (42.9% vs 4.8%, P=.011). Long-term mortality was 53.3% among patients with baseline MELD≥20 and 7.5% among those with MELD<20 (P<.0001). Among deceased patients 75% were Child-Turcotte-Pugh class C at baseline, while among survivors 83.9% were class A or B (P<.0001). Direct acting antivirals-based treatments for severe post-transplant hepatitis C recurrence, comprising fibrosing cholestatic hepatitis, significantly improve liver function, even without viral clearance and permit an excellent long-term survival. The setting of severe HCV recurrence may require the identification of "too-sick-to-treat patients" to avoid futile treatments.

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Section: Outcomes In Patients With Fch and In Cirrhoticsmentioning

confidence: 87%

Section: Clinical Outcomesmentioning

confidence: 96%

Section: Introductionmentioning

confidence: 99%

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Long‐term outcomes of direct acting antivirals in post‐transplant advanced hepatitis C virus recurrence and fibrosing cholestatic hepatitis

Vukotic¹,

Conti²,

Fagiuoli

et al. 2017

Journal of Viral Hepatitis

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“…Although the evaluation of AT response is often based more on virology than on histology, it has been reported that IFN may play an antifibrotic effect even in those patients in whom an antiviral effect is not observed [95]. Moreover, AT seems to slow down disease progression in SVR [96] and increases patient survival in treated LT recipients [97][98][99]. Table 2 summarizes data on post-treatment fibrosis modification [96,[100][101][102][103][104][105][106][107][108][109][110][111][112][113][114].…”

Section: Fibrosis Progression After Liver Transplantation: Is Better mentioning

confidence: 99%

Hepatitis C virus and liver transplantation: where do we stand?

et al. 2015

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SummaryThe hepatitis C virus (HCV) infects more than 180 million people globally, with increasing incidence, especially in developing countries. HCV infection frequently progresses to liver cirrhosis leading to liver transplantation or death, and HCV recurrence still constitutes a major challenge for the transplant team. Antiviral therapy is the only available instrument to slow down this process, although its actual impact on liver histology, in responders and nonresponders, is still controversial. We are now facing a "new era" of direct antiviral agents that is already changing the approach to HCV burden both in the pre-and in the post-liver transplantation settings. Available data on sofosbuvir/ledipasvir and sofosbuvir/ simeprevir in patients with decompensated cirrhosis sustain a SVR12 of 89% [1], but one-third of patients do not clinically improved. The sofosbuvir/ribavirin treatment in stable cirrhotic patients with HCC before liver transplantation is associated with 2% recurrence rate if liver transplantation is performed at least one month after undetectable HCV-RNA is achieved. The treatment of recurrence with the new antiviral drugs is associated with a SVR that ranges between 60 and 90%. In this review, we have focused on the evolution of antiviral therapy for HCV recurrence from the "old" interferon-based therapy to the "new" interferon-free regimens, highlighting useful information to aid the transplant hepatologist in the clinical practice.

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Female gender in the setting of liver transplantation

Rodríguez–Castro¹

2014

WJT

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The evolution of liver diseases to end-stage liver disease or to acute hepatic failure, the evaluation process for liver transplantation, the organ allocation decision-making, as well as the post-transplant outcomes are different between female and male genders. Women's access to liver transplantation is hampered by the use of model for end-stage liver disease (MELD) score, in which creatinine values exert a systematic bias against women due to their lower values even in the presence of variable degrees of renal dysfunction. Furthermore, even when correcting MELD score for gender-appropriate creatinine determination, a quantifiable uneven access to transplant prevails, demonstrating that other factors are also involved. While some of the differences can be explained from the epidemiological point of view, hormonal status plays an important role. Moreover, the pre-menopausal and post-menopausal stages imply profound differences in a woman's physiology, including not only the passage from the fertile age to the non-fertile stage, but also the loss of estrogens and their potentially protective role in delaying liver fibrosis progression, amongst others. With menopause, the tendency to gain weight may contribute to the development of or worsening of pre-existing metabolic syndrome. As an increasing number of patients are transplanted for non-alcoholic steatohepatitis, and as the average age at transplant increases, clinicians must be prepared for the management of this particular condition, especially in post-menopausal women, who are at particular risk of developing metabolic complications after menopause.

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Long-term maintenance of sustained virological response in liver transplant recipients treated for recurrent hepatitis C

Cited by 3 publications

References 38 publications

Long‐term outcomes of direct acting antivirals in post‐transplant advanced hepatitis C virus recurrence and fibrosing cholestatic hepatitis

Long‐term outcomes of direct acting antivirals in post‐transplant advanced hepatitis C virus recurrence and fibrosing cholestatic hepatitis

Hepatitis C virus and liver transplantation: where do we stand?

Female gender in the setting of liver transplantation

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