Significant improvement in the outcome of HCV-infected transplant recipients by avoiding rapid steroid tapering and potent induction immunosuppression.
OBJECTIVE
Recurrent HCV-cirrhosis occurs in a substantial proportion of transplant recipients, with higher rates reported in patients who had recently received a transplant. Over-immunosuppression has been implicated in this more unfavorable outcome. To determine whether the implementation of specific measures aimed at reducing or avoiding negative predictive variables is associated with an improvement in the outcome of recurrent hepatitis C.


METHODS
Comparative study between a cohort of patients who had recently received a transplant (2001-2004) and a historical group of HCV-infected patients transplanted before the implementation of two simple measures (1999-2000): (i) use of dual initial immunosuppression (steroids + cyclosporine neoral or tacrolimus); (ii) slow steroid tapering (>6 months). Yearly biopsies were performed in these recipients, and only those with at least one protocol biopsy and those with cholestatic hepatitis (regardless of follow-up) were included in the study. End-point: rate of HCV-related severe disease (defined as bridging fibrosis, cirrhosis or fibrosing cholestatic hepatitis) within the first year post-transplantation.


RESULTS
Severe disease was significantly lower in this cohort compared to the historical group (26/90, 29% vs 25/52, 48%; p=0.02). While other factors remained unchanged between the two cohorts, the proportion of patients on triple-quadruple regimes and the number of boluses of methyl-prednisolone were lower and the duration of prednisone therapy longer in more patients who had recently received a transplant.


CONCLUSIONS
Improving the outcome of recurrent hepatitis C may be achieved by reducing overall immunosuppression and avoiding abrupt variations in immunosuppression.
HepatoGastroenterology Service, Servicio de HepatoGastroenterología, Hospital Universitario La Fe, Avenida Campanar 21, 46009 Valencia, Spain. mbhaym@teleline.es
Marina
M
Berenguer
Victoria
V
Aguilera
Martín
M
Prieto
Fernando
F
San Juan
José M
JM
Rayón
Salvador
S
Benlloch
Joaquín
J
Berenguer
D000328:Adult; D000368:Aged; D001706:Biopsy; D015331:Cohort Studies; D016572:Cyclosporine / Q000276:immunology / Q000627:therapeutic use; D018450:Disease Progression; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination; D005260:Female; D016174:Hepacivirus / Q000276:immunology; D006526:Hepatitis C / Q000188:drug therapy* / Q000209:etiology* / Q000601:surgery; D006801:Humans; D007165:Immunosuppression Therapy / Q000379:methods*; D007166:Immunosuppressive Agents / Q000008:administration & dosage* / Q000009:adverse effects / Q000276:immunology; D008099:Liver / Q000473:pathology / Q000821:virology; D016031:Liver Transplantation / Q000009:adverse effects* / Q000276:immunology; D008297:Male; D008875:Middle Aged; D011241:Prednisone / Q000276:immunology / Q000627:therapeutic use; D012008:Recurrence; D012720:Severity of Illness Index; D013256:Steroids / Q000008:administration & dosage* / Q000009:adverse effects / Q000276:immunology; D016559:Tacrolimus / Q000276:immunology / Q000627:therapeutic use; D013997:Time Factors; D016896:Treatment Outcome
D007166:Immunosuppressive Agents; D013256:Steroids; D016572:Cyclosporine; D011241:Prednisone; D016559:Tacrolimus