Treatment of hepatitis C virus infection in the allograft

Neuberger, James

doi:10.1053/jlts.2003.50250

Cited by 19 publications

(11 citation statements)

References 35 publications

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“…The length of stay was about 1 week longer at reTX (second transplant, median days Ϯ standard deviation, 13 Ϯ 4 vs. 19 Ϯ 3 ). Interestingly, ICU days were similar among groups and transplants (first transplant, median days, 2 Ϯ 0.5 vs. 3 Ϯ 0.5 [1][2][3][4][5][6][7][8][9][10]; second transplant, median days 3 Ϯ 2 [1-70] in both groups). In group 1, 21 (49%) patients were hospitalized at the time of reTX and 4 (9%) were in the ICU.…”

Section: Days Of Hospitalization and Intensive Care Unit (Icu)mentioning

confidence: 99%

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Retransplantation for hepatitis C: Results of a U.S. multicenter retransplant study

et al. 2007

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It is widely perceived that outcomes are relatively poor following retransplantation (reTX) for recurrent of hepatitis C virus (HCV) infection. Transplant centers debate the utility of offering another liver to these patients. A U.S. study group was formed to retrospectively compare survival after reTX in patients with recurrent HCV (histologically proven) and those transplanted for other indications greater than 90 days after first transplantation, from 1996 to 2004. Patients were divided into 3 groups; group 1: HCV reTX (n ϭ 43), group 2: non-HCV reTX (n ϭ 73), and group 3: recurrent HCV but no reTX (n ϭ 156). They were predominantly male, Caucasian, with mean age of 47.2 yr. The commonest indications for non-HCV reTX were chronic rejection (36%), hepatic artery thrombosis (31%) and recurrent primary sclerosing cholangitis (17%). Duration of hospitalization, number of intensive care unit (ICU) days, and time interval from listing to transplantation or reTX were similar between reTX groups. The 1-yr and 3-yr survival rates after reTX were also similar for HCV reTX and non-HCV reTX groups (1 yr, 69% vs. 73%; 3 yr, 49% vs. 55%). Model for End-Stage Liver Disease (MELD) scores were not predictive of survival from reTX. However, with a MELD score of Ͼ30 in the non HCV group, survival was Ͻ50%. In the recurrent HCV not undergoing reTX group, 30% were reevaluated for reTX but only 15% were listed for reTX and the 3-yr survival was 47%. The most common reasons for not listing for reTX were recurrent HCV within 6 months (22%), fibrosing cholestatic hepatitis (19%), and renal dysfunction (9%). In conclusion, patients retransplanted for recurrent HCV had similar 1-yr and 3-yr survival when compared to patients undergoing reTX for other indications. MELD scores were not predictive of post-reTX survival. Survival was Ͻ50% in the non-HCV reTx group with MELD score of Ͼ30. Many patients with recurrent HCV are not considered for reTX and die from recurrent disease.

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Section: Days Of Hospitalization and Intensive Care Unit (Icu)mentioning

confidence: 99%

“…1,2 Efficacy of treatment of the recurrent HCV is limited by many factors, including drug toxicity and immunosuppression, with sustained virological response rates in the range of 30%. 3,4 The progression to graft failure is significant and liver transplant centers are debating the issue of retransplantation (reTX).…”

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confidence: 99%

Retransplantation for hepatitis C: Results of a U.S. multicenter retransplant study

et al. 2007

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“…Treatment of recurrent HCV infection is cumbersome and complicated by the lower patient tolerability necessitating frequent dose adjustment, adjuvant hematopoietic/leukopoietic agents, and, oftentimes, treatment discontinuation. Approximately 30% to 60% of the treated patients require ribavirin dose reduction, and 30% need discontinuation of therapy for myriad reasons, including depression (∼10% of patients) 86, 91. To date, there is no compelling evidence that interferon α increases the risk of acute or chronic cellular rejection.…”

Section: Natural History Of Recurrent Hcv Infectionmentioning

confidence: 99%

Management of hepatitis C virus infection in the setting of liver transplantation

Rodriguez-Luna

Vargas

2005

Liver Transpl

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C hronic hepatitis C virus (HCV) infection is common and affects a significant proportion of the world population, with an estimated 170 million people infected and 3 to 4 million new cases per year. 1,2 HCV-related cirrhosis is the most common indication for liver transplantation (LT) in the United States and most European countries. [3][4][5][6][7] In the United States, over one-third of available liver allografts are transplanted into recipients with chronic HCV infection. In fact, despite a decline in the incidence of new HCV cases, the prevalence of infection will not peak until the year 2040. 5 As the duration of infection increases, the number of new patients with cirrhosis will double by the year 2020 in an untreated patient population. 5 If this model is correct, the projected increase in the need for LT secondary to chronic HCV infection will place a burden that may be impossible to meet on an already limited supply of organ donors.In this article, we review the natural history of HCV in the transplantation population, risk factors associated with severity of recurrence, histological changes associated with recurrence of disease, treatment strategies, and the role of retransplantation. Natural History of Recurrent HCV Infection Virological RecurrenceThe clinical history of recurrent HCV infection as defined by detectable HCV RNA in serum is almost a universal phenomenon. 4,[8][9][10][11][12] Reinfection of the liver allograft has been recognized at the virological level by either an increasing level of serum HCV RNA or detection of HCV RNA in the allograft itself. 13 In fact, while the interval between LT and clinical allograft infection varies, the presence of negative-strand HCV RNA, the sine qua non of HCV replication, in serum has been recorded as early as 48 hours after LT and hepatocyte expression of HCV antigens as early as 10 days after LT (25% of patients). 11,12,14,15 A recent study of post-LT hepatitis C viral kinetics showed that the first round of infection likely occurs during reperfusion of the graft. In this study, serum viral levels reached pre-LT titers by postoperative day 4 in a significant number of patients. Viral load then tended to increase over the ensuing weeks, reaching a plateau at approximately 1 month after LT. 16 Serum levels of HCV RNA peak at 1 to 3 months, achieving 1-year post-LT levels that are 10-to 100-fold greater than the mean pre-LT levels. 11,17 Viral titers at 1 year after LT usually plateau at 1 to 2 logs higher than pre-LT levels.

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“…Autoptische Untersuchungen schätzen die Prävalenz der Leberzirrhose auf 0%. Sie ist in Europa mit 22.924 Transplantationen bis 200 die häufigste Ursache für eine Lebertransplantation [5]. An der Medizinischen Hochschule Hannover wurden von den im Zeitraum 972 bis 2003 durchgeführten 99 Transplantationen 28,5% wegen einer Zirrhose indiziert (.…”

Section: Ultimative Therapieoptionunclassified

“…Problematisch ist nach wie vor eine praktisch 00%ige Rate der Reinfektion der Spenderleber mit dem HCV-Virus [22]. Diese führt im Verlauf von Monaten in 80% der Patienten zur Spenderleberhepatitis, in 2-8% zu einer fibrocholestatischen Hepatitis und über Jahre in 6-30% zu einer erneuten Leberzirrhose.…”

Section: Hepatitis Cunclassified

Lebertransplantation zwischen Indikation und Spenderallokation

Strassburg¹,

Becker²,

Klempnauer³

et al. 2004

Internist

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Liver transplantation represents an established therapeutic option for advanced liver diseases. The spectrum of indications encompasses infectious, vascular, immunological and toxic diseases leading to cirrhosis, in addition to genetic, metabolic, developmental and selected neoplastic diseases. On the one hand the timing of liver transplantation is determined by the disease specific course until decompensation and the disease manifestation involving bile ducts or hepatocytes. On the other hand it represents gene therapy of diseases affecting the liver, or entities where the genetic defect lies in the liver. In view of the shortage of donor organs and an increasing requirement for liver transplantation the challenge is to provide an effective and fair waiting list management. Reform of allocation criteria has put the focus on urgency. This in turn leads to an increase in waiting time for elective transplantations, inclusion of end stage diseases and critical patients, higher perioperative costs, problems with the matching of organs and the problem of an effective use of organ resources. Fair allocation and medical necessity therefore define the challenges surrounding the indications for liver transplantation.

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Treatment of hepatitis C virus infection in the allograft

Cited by 19 publications

References 35 publications

Retransplantation for hepatitis C: Results of a U.S. multicenter retransplant study

Retransplantation for hepatitis C: Results of a U.S. multicenter retransplant study

Management of hepatitis C virus infection in the setting of liver transplantation

Lebertransplantation zwischen Indikation und Spenderallokation

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