title: Topical testosterone treatment for chronic allograft failure in liver transplant recipients with recurrent hepatitis C virus.
abstract: BACKGROUND
  Liver transplant recipients with allograft failure due to recurrent hepatitis C virus (HCV) infection often develop marked muscle wasting and ascites prior to death and are denied repeat liver transplantation. We sought to determine whether topical testosterone therapy is associated with improved muscle mass and survival in patients with chronic allograft failure post-liver transplant.
  
  
  METHODS
  We performed a retrospective review of liver transplant recipients with chronic allograft failure. Group 1 patients were treated for >6 months with testosterone gel 1%; group 2 patients were untreated.
  
  
  RESULTS
  Fourteen patients were identified with stage 3 or 4 fibrosis, muscle wasting, and allograft failure due to recurrent HCV. Group 1 (n=9) patients had statistically significant improvement in albumin, testosterone, muscle strength, well-being, and MELD/CTP scores, while there was no improvement seen for any of these parameters in group 2 (n=5). There were no deaths in group 1, while four of five patients in group 2 died on average 84 days posttransplant. Adverse effects of testosterone treatment included lower extremity edema (which resolved upon dose adjustment), hypertension, and pruritus.
  
  
  CONCLUSIONS
  Topical testosterone gel appears to increase muscle strength, stimulate albumin synthesis, and improve survival in patients with allograft failure post-liver transplant.
authors.affiliation: University of Cincinnati, School of Medicine, Cincinnati, Ohio 45267-0595, USA. guy.neff@UC.edu
authors.forename: G W
authors.initials: GW
authors.lastname: Neff
authors.forename: C B
authors.initials: CB
authors.lastname: O'Brien
authors.forename: N J
authors.initials: NJ
authors.lastname: Shire
authors.forename: A
authors.initials: A
authors.lastname: DeManno
authors.forename: S
authors.initials: S
authors.lastname: Kahn
authors.forename: E
authors.initials: E
authors.lastname: Rideman
authors.forename: K
authors.initials: K
authors.lastname: Safdar
authors.forename: J
authors.initials: J
authors.lastname: Madariaga
authors.forename: S R
authors.initials: SR
authors.lastname: Rudich
mesh_terms: D000287:Administration, Topical; D000998:Antiviral Agents / Q000627:therapeutic use; D006526:Hepatitis C / Q000188:drug therapy / Q000601:surgery*; D006801:Humans; D016031:Liver Transplantation / Q000502:physiology*; D018482:Muscle, Skeletal / Q000187:drug effects / Q000503:physiopathology; D012008:Recurrence; D012189:Retrospective Studies; D013739:Testosterone / Q000008:administration & dosage / Q000627:therapeutic use*; D014184:Transplantation, Homologous / Q000502:physiology*; D017211:Treatment Failure
chemical_list: D000998:Antiviral Agents; D013739:Testosterone