Splenectomy and antiviral treatment for thrombocytopenic patients with chronic hepatitis C virus infection

Abstract

Thrombocytopenic patients with chronic hepatitis C virus (HCV) infection are poor candidates for antiviral treatment with interferon (IFN), but no standard treatment for thrombocytopenia has yet been established. We evaluated the safety of splenectomy and its efficacy for the initiation and continuation of antiviral therapy. From March 2003 to April 2006, 10 patients (mean age 62.5 years) with HCV-related cirrhosis, low platelet count (<==106 000/mm(3)) and splenomegaly (spleen size >==10 cm) underwent splenectomy. Platelet counts significantly increased at 4-8 weeks after splenectomy [pre: 64 200 +/- 6900/mm(3)vs post 209 000 +/- 40 600/mm(3) (P = 0.004)]. No severe operative complications were observed. All patients subsequently received antiviral therapy. Of the eight patients who were infected with HCV genotype 1 and had a high viral load (>==100 KIU/mL), four received combination therapy with pegylated IFNalpha-2b plus ribavirin, and the other four received standard IFNalpha-2b plus ribavirin. One patient infected with HCV genotype 2 and another with HCV genotype 1 and a low viral load (<100 KIU/mL) were treated with pegylated IFNalpha-2a. Six patients achieved sustained virologic response (SVR). Among four patients who failed to achieve SVR, one was given retreatment with pegylated IFN plus ribavirin, and the other three received low-dose long-term IFN therapy. Although this study was small, the treatment results were similar to those for patients without thrombocytopenia and suggested that splenectomy would not reduce the antiviral efficacy of IFNalpha-based treatment.

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.…”

“…A previous study [24] indicated that the SVR rate in patients with genotype 1 was 33%, compared to a rate of 100% in patients with genotype 2. In addition, previous studies of IFN-based therapy after splenectomy [20][21][22] showed that SVR was achieved only in patients with genotypes 2b and 1b with a low viral load. Besides, in our study, it was notable that under the condition that the Fig.…”

“…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.…”

Successful use of splenectomy in a patient with hepatitis C virus-related thrombocytopenia

“…Although the guidelines indicated splenectomy can be a useful way to increase platelet count for these patients, these studies were small; only a few successful cases reported specifically on these patients whose platelet count was more than 50×10 9 /l, guaranteeing the success of operation [9][10][11][12]. We seldom found case reports in which platelets were as low as below 10×10 9 /l with splenectomy.…”