Partial Splenic Embolization for the Treatment of Hypersplenism in Liver Transplanted Patients with Hepatitis C Virus Recurrence before peg-Interferon Plus Ribavirin

Bárcena, Rafael; Gil-Grande, L; Moreno, Javier; Foruny, José Ramón; Oton, E.; García, Miguel López; Blázquez, Javier; Sánchez, Juan; Moreno, Ana; Moreno, Alberto

doi:10.1097/01.tp.0000155424.52939.3d

Cited by 20 publications

(18 citation statements)

References 7 publications

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“…Our rate of treatment discontinuation due to adverse events was 29%, compared to about 10% among immunocompetent subjects (15). There were three episodes of cholangitis, which led to therapy withdrawal, and 1 patient died.…”

Section: Peg-interferon/ribavirin In Liver Transplantationmentioning

confidence: 88%

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Hepatitis C Recurrence After Liver Transplantation: Viral and Histologic Response to Full-Dose Peg-Interferon and Ribavirin

Oton

Bárcena

Moreno-Planas

et al. 2006

American Journal of Transplantation

123

101

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Hepatitis C recurrence after liver transplantation (LT) is universal, and frequently leads to cirrhosis and death. The aim of our study was to assess the efficacy and safety of 48-weeks of full-dose peg-interferon-a-2a (n = 4) or a -2b (n = 51) plus ribavirin (>11 mg/kg/day) in a multicentric cohort of 55 patients ≥12 months after LT. All subjects had histologically proven HCV recurrence, excluding severe cholestatic recurrence. Mean age was 54.3 ± 9.7, 77% male, 90.9% genotype 1, 32.7% cirrhotics. All but 5 patients received monotherapy with tacrolimus (54.5%), cyclosporine (30.7%) or mycophenolate mofetil (5.5%). The rates of end-of-treatment response and sustained virological response (SVR) were 66.7% and 43.6%, respectively. Low baseline HCV-RNA (p = 0.005) and a length from LT to therapy between 2-4 years (p = 0.011) were predictors of SVR. The lack of achieving a viral load decrease ≥1-log 10 at week 4 and/or 2-log 10 at week 12 was 100% predictive of failure. The most frequent side effects were neutropenia (76,4%), anemia (60%) and infectious complications (30.9%). Toxicity led to peg-interferon withdrawal in 16 (29%) subjects. In 15 patients with post-treatment biopsy, the histological activity index was significantly improved (p = 0.006), whereas fibrosis did not change (p = 0.14). Three patients died (cholangitis, hepatic artery thrombosis and lung cancer). In conclusion, HCV therapy after LT was very effective, although it led to a significant rate of toxicity.

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Section: Peg-interferon/ribavirin In Liver Transplantationmentioning

confidence: 88%

“…Two patients with hypersplenism-related severe thrombocytopenia underwent successful partial splenic embolization to improve platelet count enough prior to HCV treatment (15).…”

Section: Patients Featuresmentioning

confidence: 99%

Hepatitis C Recurrence After Liver Transplantation: Viral and Histologic Response to Full-Dose Peg-Interferon and Ribavirin

Oton

Bárcena

Moreno-Planas

et al. 2006

American Journal of Transplantation

123

101

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“…It has been successful in patients with thrombocytopenia and recurrent HCV infection who were able to undergo treatment with interferon and ribavirin as a result of ablation. [83][84][85][86] Many patients develop post-embolization syndrome, including symptoms of fever, left upper quadrant pain, pleural effusion, pneumonia, and atelectasis. Splenic abscesses and rupture are infrequent and are more commonly encountered and less tolerated by immunocompromised cirrhotic patients with a greater area of embolization.…”

Section: Partial Splenic Embolization (Pse)mentioning

confidence: 99%

Chronic hepatitis C-associated thrombocytopenia: aetiology and management

Fouad

2013

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Thrombocytopenia is perhaps the most common haematological abnormality in patients with chronic hepatitis C virus (HCV) infection. In these patients, the presence of thrombocytopenia may be a limiting factor when considering antiviral therapy and may be associated with decreased sustained virological response rates. Thrombocytopenia may interfere with diagnostic procedures such as liver biopsy, because of risk of bleeding.Pathogenetic mechanisms include hypersplenism secondary to portal hypertension, bone marrow suppression resulting from either HCV itself or interferon treatment, and aberrations of the immune system resulting in the formation of anti-platelet antibodies and/or immunecomplexes that bind to platelets and facilitate their premature clearance. The ability to increase platelet levels could significantly reduce the need for platelet transfusions and facilitate the use of interferon-based antiviral therapy and other medically indicated treatments in patients with liver disease. Therapeutic options include pharmacological and non-pharmacological therapies. This review summarizes the available data on these therapeutic options. KEYWORDS: thrombocytopenia, hepatitis C virus (HCV), cytokines Definition and prevalenceThrombocytopenia has been defined as a platelet count <150,000 cells/µL. In a recent systematic review, the definitions of thrombocytopenia varied between studies and were based either on platelet counts, with threshold levels ranging between <100,000 cells/µL and <180,000 cells/µL or on criteria set in haematological guidelines. The prevalence of thrombocytopenia related to chronic liver disease has been reported as 15% to 70% in patients with advanced fibrosis and portal hypertension, depending on the stage of the disease and the platelet level used to define thrombocytopenia. In patients with chronic HCV infection, the prevalence of thrombocytopenia ranged from 0.16% to 45.4% and more than half of the studies reported a prevalence of 24% or more. 1 Aetiology of thrombocytopenia in patients with chronic HCVThe pathophysiology of thrombocytopenia in patients with HCV-related chronic liver disease is complex and involves the interaction of multiple factors. In general, these factors may be

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“…It has been successful in patients with thrombocytopenia and recurrent HCV who were able to undergo treatment with interferon and ribavirin as a result of ablation [23][24][25] . Most patients develop post-embolization syndrome, including symptoms of fever, left upper quadrant pain, pleural effusion, pneumonia, and atelectasis.…”

Section: Partial Splenic Artery Embolizationmentioning

confidence: 99%

Treatment modalities for hypersplenism in liver transplant recipients with recurrent hepatitis C

Sibulesky

Nguyen

Paz‐Fumagalli

et al. 2009

WJG

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Hepatitis C is the most common indication for orthotopic liver transplantation in the United States. Unfortunately, hepatitis C recurs universally in the transplanted liver and is the major cause of decreased graft and patient survival. The combination therapy of interferon and ribavirin has been shown to be the most effective therapy for recurrent hepatitis C. However, pre-and post-transplant hypersplenism often precludes patients from receiving the antiviral therapy. Splenectomy and partial splenic embolization are the two invasive modalities that can correct the cytopenia associated with hypersplenism. In this report we review the two treatment options, their associated outcomes and complications.

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Partial Splenic Embolization for the Treatment of Hypersplenism in Liver Transplanted Patients with Hepatitis C Virus Recurrence before peg-Interferon Plus Ribavirin

Cited by 20 publications

References 7 publications

Hepatitis C Recurrence After Liver Transplantation: Viral and Histologic Response to Full-Dose Peg-Interferon and Ribavirin

Hepatitis C Recurrence After Liver Transplantation: Viral and Histologic Response to Full-Dose Peg-Interferon and Ribavirin

Chronic hepatitis C-associated thrombocytopenia: aetiology and management

Treatment modalities for hypersplenism in liver transplant recipients with recurrent hepatitis C

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