Successful Treatment of Fibrosing Cholestatic Hepatitis After Liver Transplantation

Çimşit, Bayındır; Assis, David N.; Caldwell, Cary; Arvelakis, Antonios; Taddei, Tamar H.; Kulkarni, Sanjay; Schilsky, Michael L.; Emre, Sükrü

doi:10.1016/j.transproceed.2011.02.034

Cited by 18 publications

(25 citation statements)

References 4 publications

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“…4 A proportion of patients (2-14%) who undergo liver or kidney transplant develop early severe recurrence (classically defined as within 6 months of transplant). [5][6][7] The most aggressive form of HCV recurrence presents as cholestatic hepatitis (also called fibrosing cholestatic hepatitis [FCH]). Treatment of severe HCV recurrence with Pegylated Interferon (PEG-interferon) and ribavirin was associated with low response, high rate of adverse effects, and an associated mortality of up to 81%.…”

mentioning

confidence: 99%

Early Acute Severe HCV Recurrence After Transplantation: From Universal Mortality to Cure

Wadhawan¹,

Vij

Makki

et al. 2017

Journal of Clinical and Experimental Hepatology

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Acute severe recurrence of hepatitis C virus (HCV) after solid organ transplant is associated with high mortality. Pegylated interferon and ribavirin are suboptimal in treatment of this severe form of recurrence. We report 4 cases of acute severe HCV recurrence (within 6 months after transplant), including 3 cases with fibrosing cholestatic hepatitis treated with sofosbuvir and ribavirin. All four patients achieved a rapid suppression of HCV RNA with a normalization of liver function tests within 4 weeks of starting therapy. All patients were HCV RNA negative at 12 weeks after stopping therapy. The combination was found to be safe as anemia was the only adverse effect, which developed in 2 patients (1 patient required blood transfusion, while another managed with erythropoietin). Sofosbuvir and ribavirin appear to be safe and efficacious in treatment of acute severe HCV recurrence after organ transplant. ( J CLIN EXP HEPATOL 2017;7:28-32)

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mentioning

confidence: 99%

Early Acute Severe HCV Recurrence After Transplantation: From Universal Mortality to Cure

Wadhawan¹,

Vij

Makki

et al. 2017

Journal of Clinical and Experimental Hepatology

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“…The incidence of fibrosing cholestatic hepatitis was obtained from a literature review. 22,23 In our model, we calculated that fibrosing cholestatic hepatitis would occur within 3 months of liver transplant.…”

Section: Natural Historymentioning

confidence: 99%

“…There were also 15,26 In our model, we further assumed that patients would start antiviral therapy soon after a diagnosis of fibrosing cholestatic hepatitis since time to diagnosis can be a predictor of mortality. 27,28 Model assumptions In our model, we had a number of important assumptions: (1) repeat liver transplant is not available; (2) pretransplant SVR is durable after transplant; (3) HCV infection does not affect the likelihood of acute or chronic rejection; (4) viral suppression does not affect HCC recurrence before or after transplant; (5) posttransplant survival after an SVR is similar to that shown with hepatitis B virus; (6) the dropout rate of patients waiting for liver transplant is similar between treatment responders and nonresponders, with dropout rate increasing linearly from 3 to 12 months; (7) all patients receive a liver transplant or die 12 months after being placed on a liver transplant wait list; and (8) the number of clinic visits is the same in responders and nonresponders to treatment.…”

Section: Hepatitis C Antiviral Treatmentmentioning

confidence: 99%

Untitled

Saab

Jimenez²,

Fong³

et al. 2016

Exp Clin Transplant

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Objectives: Hepatitis C virus infection is the most common underlying reason for hepatocellular carcinoma and indication for liver transplant. The increased availability of non-interferon-based therapy has expanded the number of treatment-eligible patients. Materials and Methods:We used a decision analysis model to compare 2 strategies of treating hepatitis C virus. Included patients were followed for 1 year after liver transplant. The probabilities and costs were obtained from a literature review, an expert panel, and our institution's experience. Sensitivity analyses were performed on all variables. Results: Our model demonstrated that it would be less costly to treat patients after liver transplant than to treat patients while they wait for transplant. When we compared baseline values, the cost difference between the 2 strategies was $25,011 per patient and $41,535 per sustained viral response. Overall survival was 60.1% for both strategies. Our model was robust across most of the variables tested in the sensitivity analysis. Conclusions: Our results indicated that there is no substantial pharmacoeconomic or survival advan tage of treating hepatitis C virus in patients with compensated cirrhosis and hepatocellular carcinoma before liver transplant versus after transplant.

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“…In addition, fibrosing cholestatic hepatitis (FCH) can occur in HCV-infected patients following KT [20] . It typically develops during the period of maximal immunosuppression (1-4 mo after KT) and is associated with progressive cholestatic, mild elevation of serum alanine aminotransferase (ALT), and high HCV viremia level [20][21][22] . FCH is associated with very high morbidity and mortality rates.…”

Section: Ktmentioning

confidence: 99%

“…FCH is associated with very high morbidity and mortality rates. IFN-based treatment is often ineffective and is associated with a risk of graft rejection [20][21][22] .…”

Section: Ktmentioning

confidence: 99%

Management of patients with hepatitis C infection and renal disease

Bunchorntavakul

Maneerattanaporn

Chavalitdhamrong

2014

WJH

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Hepatitis C virus (HCV) infection in patients with end-stage renal disease (ESRD) is associated with more rapid liver disease progression and reduced renal graft and patients' survival following kidney transplantation. Evaluations and management of HCV in patients with renal disease are challenging. The pharmacokinetics of interferons (IFN), ribavirin (RBV) and some direct acting antiviral (DAA), such as sofosbuvir, are altered in patients with ESRD. With dose adjustment and careful monitoring, treatment of HCV in patients with ESRD can be associated with sustained virological response (SVR) rates nearly comparable to that of patients with normal renal function. DAA-based regimens, especially the IFN-free and RBV-free regimens, are theoretically preferred for patients with ESRD and KT in order to increase SVR rates and to reduce treatment side effects. However, based on the data for pharmacokinetics, dosing safety and efficacy of DAA for patients with severe renal impairment are lacking. This review will be focused on the evaluations, available pharmacologic data, and management of HCV in patients with severe renal impairment, patients who underwent KT, and those who suffered from HCV-related renal disease, according to the available treatment options, including DAA.

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Successful Treatment of Fibrosing Cholestatic Hepatitis After Liver Transplantation

Cited by 18 publications

References 4 publications

Early Acute Severe HCV Recurrence After Transplantation: From Universal Mortality to Cure

Early Acute Severe HCV Recurrence After Transplantation: From Universal Mortality to Cure

Untitled

Management of patients with hepatitis C infection and renal disease

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