[National survey about management and treatment options of hepatitis C recurrence after liver transplantation].
BACKGROUND
Recurrence of hepatitis C after orthotopic liver transplantation is one of the major clinical challenges faced by the liver transplantation community. Treatment of hepatitis C recurrence with peguilated interferon and ribavirin has been associated with sustained virological response in 21% to 45% of treated patients. Furthermore, it has been shown to halt disease progression after orthotopic liver transplantation and to prevent graft failure and the need for retransplantation at least in those subjects with sustained virological response. However, treatment of hepatitis C recurrence after orthotopic liver transplantation in Brazil was not recommended according to ministerial Law number 863.


OBJECTIVE
To assess the management and treatment options of hepatitis C recurrence after orthotopic liver transplantation in different liver transplantation centers in Brazil.


METHODS
Inquiries were sent to active liver transplantation centers throughout the country.


RESULTS
Nineteen centers accepted to participate and answered the questionnaire. Altogether they transplanted around 2,800 subjects, half of them with hepatitis C. Immunosuppressive regimen is comprised by tacrolimus and short-term prednisone in 53% of the centers. One third of them claim to use different schedules for hepatitis C patients. Protocol biopsies for diagnosis of recurrence are employed by 13 centers. Different histological criteria are used for the either diagnosis or decision for treatment in most of the centers. Approximately half of them (42%) indicate treatment in subjects with less severe stages of fibrosis (less than F2 according to METAVIR classification). All centers are referring patients for treatment with peguilated interferon and ribavirin, for 1 year, for 6 months or 1 year based on the genotype, or a la carte based on response, respectively, in 32%, 21% and 47% of the centers. Most of them (84%) do not stop treatment in early non-responders at the 12th week.


CONCLUSIONS
Even in the absence of national guidelines and federal support, most of the liver transplantation centers in Brazil are treating patients with hepatitis C recurrence after orthotopic liver transplantation.
Bittencourt
Paulo Lisboa
PL
Hospital Português, Salvador, BA. plbbr@uol.com.br
Silva
Rita de Cássia Silva Martins Alves da
Rde C
Pessoa
Mário Guimarães
MG
Marroni
Cláudio Augusto
CA
D000998:Antiviral Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D001938:Brazil; D002985:Clinical Protocols; D019538:Health Care Surveys; D006526:Hepatitis C / Q000188:drug therapy*; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D008103:Liver Cirrhosis / Q000601:surgery / Q000821:virology; D016031:Liver Transplantation; D012008:Recurrence; D011795:Surveys and Questionnaires
D000998:Antiviral Agents; D007166:Immunosuppressive Agents