Long-term outcome of hepatitis C infection after bone marrow transplantation

Abstract

Chronic hepatitis C is often asymptomatic, at least during the first decade following hematopoietic stem cell transplantation. Progression to advanced liver disease or cirrhosis in patients surviving more than 10 years is currently thought to be rare. Among 1078 patients who underwent an allogeneic transplantation between January 1973 and January 1995, 96 patients infected by hepatitis C virus (HCV) during the transplantation period were studied. Cumulative incidence and analysis of risk factors for cirrhosis were analyzed, and the rate and risk of cirrhosis in transplant recipients were compared with those of 158 HCV-infected controls who did not receive transplants. At a median follow-up of 15.7 years, 15 patients developed biopsy-proven cirrhosis, leading to a cumulative incidence of cirrhosis of 11% and 24% at 15 and 20 years, respectively. By multivariate analysis, extrahepatic HCV manifestations and HCV genotype 3 were associated with risk of cirrhosis. The median time to cirrhosis in transplant recipients was 18 years as compared with 40 years in the control population. The risk of cirrhosis in transplant recipients relative to controls was significantly higher by multivariate analysis (P ‫؍‬ .0008). Roughly a quarter of long-term HCV-infected survivors with transplants progressed to cirrhosis that is much more rapid than in patients without transplants. Systematic detection of HCV infection, liver biopsy, and therapeutic intervention are therefore warranted in long-term marrow transplant

Long-term outcome after allo-SCT: close follow-up on a large cohort treated with myeloablative regimens

“…In a study from France, 96 patients who acquired HCV-infection during HSCT were followed up for a median of 15.7 years, 15 patients developed biopsy-proven liver cirrhosis. 33 The reported median time to cirrhosis in transplant recipients was 18 years compared with 40 years in HCV-infected patients without transplant. 33 Strasser et al 34 found that cirrhosis after HSCT was mainly attributed to hepatitis C. In another study from the same group on long-term survivors, with over 10 years follow-up, HCV infection was not associated with excess mortality.…”

“…33 The reported median time to cirrhosis in transplant recipients was 18 years compared with 40 years in HCV-infected patients without transplant. 33 Strasser et al 34 found that cirrhosis after HSCT was mainly attributed to hepatitis C. In another study from the same group on long-term survivors, with over 10 years follow-up, HCV infection was not associated with excess mortality. 35 Most patients have adequate immune reconstitution by 1 year after transplant, but patients with cGVHD remain immunoincompetent and are at higher risk of infections.…”

Long-term follow-up of HCV-infected hematopoietic SCT patients and effects of antiviral therapy

“…A couple of long-term follow-up studies analyzing retrospectively the outcome of HCV-infected patients have been published. 3,4 Our study differs from the previously published studies by being prospective including a cohort of patients registered in the study between 1993 and 1996 and followed for 15 years. In addition, the study is significantly larger than the previously published studies both regarding the number of patients included and in the number of patients receiving antiviral therapy against HCV.…”

“…Nine patients are alive with documented liver cirrhosis, two additional patients have undergone liver transplantation and are currently alive and two patients died from other causes (original disease and infection) but had documented liver cirrhosis. The cumulative incidence of severe liver complications (death from liver failure, liver transplantation, living with cirrhosis 3. The sustained response rates for IFN given as a single drug were 31% (10/32) with data missing for 7 patients, 57% (16/28) for IFN in combination with ribavirin with data missing for 2 patients and 67% (6/9) for pegylated IFN in combination with ribavirin with data missing for 6 patients 3 of these not yet evaluated.…”

“…Published studies suggest that the long-term impact of HCV in HSCT patients is significant with a proportion of patients going into liver failure or developing hepatocellular carcinoma. 1 --4 Peffault de Latour et al 3 reported data from a retrospective evaluation of 96 patients infected by HCV with a median follow-up 15.7 years. The cumulative incidences of biopsy proven cirrhosis at 15 and 20 years were 11% and 24%, respectively.…”