title: Incidence, risk factors, and outcome of chronic rejection during antiviral therapy for posttransplant recurrent hepatitis C.
abstract: Antiviral therapy for recurrent hepatitis C in liver transplantation has been associated with the development of chronic rejection. The aim of this study was to assess the incidence, evolution, and risk factors associated with the development of chronic rejection during posttransplant hepatitis C virus antiviral therapy. Seventy-nine patients with posttransplant recurrent hepatitis C who were treated with pegylated interferon and ribavirin were prospectively followed. Liver biopsy was performed before antiviral therapy was initiated and when liver tests worsened during therapy. Pretransplant and posttransplant factors were analyzed as potential risk factors for the development of chronic rejection. Seven of 79 patients (9%) developed chronic rejection during antiviral therapy. The mean time from the start of treatment to the development of chronic rejection was 5.8 months (3-12 months). An analysis of factors associated with the development of chronic rejection showed that the use of cyclosporine as immunosuppression therapy (6 of 19 patients who received cyclosporine developed chronic rejection in comparison with only 1 of 57 patients who received tacrolimus; P = 0.0013), achievement of sustained virological response (P = 0.043), and ribavirin discontinuation (P = 0.027) were associated with the development of chronic rejection. In conclusion, the development of chronic rejection during posttransplant pegylated interferon and ribavirin therapy is a severe complication. The use of cyclosporine, ribavirin discontinuation, and viral infection elimination seem to be associated with the development of this complication. Liver Transpl 15:948-955, 2009. (c) 2009 AASLD.
authors.affiliation: Department of Gastroenterology, Hospital Universitario 12 de Octubre, Madrid, Spain. ifernandezv@medynet.com
authors.forename: Inmaculada
authors.initials: I
authors.lastname: Fernández
authors.forename: Esperanza
authors.initials: E
authors.lastname: Ulloa
authors.forename: Francisco
authors.initials: F
authors.lastname: Colina
authors.forename: Manuel
authors.initials: M
authors.lastname: Abradelo
authors.forename: Carlos
authors.initials: C
authors.lastname: Jiménez
authors.forename: Alberto
authors.initials: A
authors.lastname: Gimeno
authors.forename: Juan Carlos
authors.initials: JC
authors.lastname: Meneu
authors.forename: Carlos
authors.initials: C
authors.lastname: Lumbreras
authors.forename: José Antonio
authors.initials: JA
authors.lastname: Solís-Herruzo
authors.forename: Enrique
authors.initials: E
authors.lastname: Moreno
mesh_terms: D000328:Adult; D000368:Aged; D000998:Antiviral Agents / Q000627:therapeutic use*; D016572:Cyclosporine / Q000627:therapeutic use; D005260:Female; D006084:Graft Rejection; D006526:Hepatitis C / Q000188:drug therapy* / Q000209:etiology*; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D015994:Incidence; D007372:Interferons / Q000627:therapeutic use; D008099:Liver / Q000473:pathology; D008107:Liver Diseases / Q000150:complications* / Q000628:therapy*; D016031:Liver Transplantation / Q000379:methods*; D008297:Male; D008875:Middle Aged; D012254:Ribavirin / Q000627:therapeutic use; D012307:Risk Factors; D016896:Treatment Outcome
chemical_list: D000998:Antiviral Agents; D007166:Immunosuppressive Agents; D012254:Ribavirin; D016572:Cyclosporine; D007372:Interferons