Partial splenic embolization and peg‐IFN plus RBV in liver transplanted patients with hepatitis C recurrence: safety, efficacy and long‐term outcome

Abstract

Extensive PSE after LT produced significant morbidity (37.5%). Peg-IFN/RBV was completed in five out of seven (71%), with SVR in two (28.6%). RBV adjustement due to anemia was high despite EPO use. Only patients able to complete or maintain antiviral therapy survived, with long-term significant benefits in hematological parameters and liver function tests.

A retrospective cohort study of partial splenic embolization for antiviral therapy in chronic hepatitis C with thrombocytopenia

“…Thus, as in prior studies, severe thrombocytopenia did not always exclude IFN-based therapy [20][21][22][23][24][25][26][27]. During IFN-based therapy, platelet counts decreased but did not reach the discontinuance criteria.…”

“…Although several previous studies [23][24][25][26][27] have shown the possible efficacy of PSE as a useful strategy for antiviral therapy in chronic hepatitis C, the numbers of subjects in studies of PSE prior to IFN-based therapy were small, with at best 10 cases in each study. A comparative trial [24] of combination therapy with IFN and ribavirin after prior PSE treatment (n = 10) and no prior PSE treatment (n = 10) showed SVRs of 33% and 0%, respectively, in patients with genotype 1.…”

“…Splenectomy [20][21][22] and PSE [23][24][25][26][27] prior to IFN-based therapy are generally well tolerated, and their associated morbidity and mortality are acceptable. A recent comparative study [13] between PSE and splenectomy showed that splenectomy was superior in terms of increases in platelet and leukocyte counts 6 months after surgery but inferior in terms of operating time, hospital stay, volume of blood transfusion, and severity of postoperative pain.…”

“…Laparoscopic splenectomy [20][21][22] and PSE [23][24][25][26][27] have been successfully used prior to IFN-based therapy in HCV-infected cirrhotic patients, although the number of study subjects is small. Thus, these studies are preliminary, and the efficacy and safety of these procedures need to be verified by additional studies.…”

Urgent Splenectomy after Partial Splenic Embolization in Liver-Transplanted Patient: A Case Report

“…Approximately 20–30% of patients who receive a liver transplant due to hepatitis c virus hepatopathy develop cirrhosis before 5 years, and up to 14% experience a serious relapse in the first year after transplantation [1–3]. Hypersplenism in these patients results in decreased platelet levels, which does not allow treatment with pegylated interferon (Peg-IFN) and ribavirin because these drugs are associated with hematological toxicity, especially thrombocytopenia in the case of Peg-IFN.…”