Phlebotomy improves histology in chronic hepatitis C males with mild iron overload.
OBJECTIVE
To investigate the usefulness of mild iron depletion and the factors predictive for histological improvement following phlebotomy in Caucasians with chronic hepatitis C (CHC).


METHODS
We investigated 28 CHC Caucasians with persistently elevated serum aminotransferase levels and non responders to, or unsuitable for, antiviral therapy who underwent mild iron depletion (ferritin < or = 70 ng/mL) by long-term phlebotomy. Histological improvement, as defined by at least one point reduction in the staging score or, in case of unchanged stage, as at least two points reduction in the grading score (Knodell), was evaluated in two subsequent liver biopsies (before and at the end of phlebotomy, 48 +/- 16 mo apart).


RESULTS
Phlebotomy showed an excellent safety profile. Histological improvement occurred in 12/28 phlebotomized patients. Only males responded to phlebotomy. At univariate logistic analysis alcohol intake (P = 0.034), high histological grading (P = 0.01) and high hepatic iron concentration (HIC) (P = 0.04) before treatment were associated with histological improvement. Multivariate logistic analysis showed that in males high HIC was the only predictor of histological improvement following phlebotomy (OR = 1.41, 95% CI: 1.03-1.94, P = 0.031). Accordingly, 12 out of 17 (70%) patients with HIC > or = 20 micromol/g showed histological improvements at the second biopsy.


CONCLUSIONS
Male CHC Caucasian non-responders to antiviral therapy with low-grade iron overload can benefit from mild iron depletion by long-term phlebotomy.
Sartori
Massimo
M
Gastroenterology Unit, Azienda Ospedaliero-Universitaria Maggiore della Carità, Corso Mazzini, 18, 28100 Novara, Italy. sartori@fauser.edu
Andorno
Silvano
S
Rossini
Angelo
A
Boldorini
Renzo
R
Bozzola
Cristina
C
Carmagnola
Stefania
S
Del Piano
Mario
M
Albano
Emanuele
E
D000328:Adult; D000368:Aged; D005260:Female; D019698:Hepatitis C, Chronic / Q000473:pathology* / Q000503:physiopathology; D006801:Humans; D019190:Iron Overload / Q000473:pathology* / Q000503:physiopathology / Q000628:therapy*; D008099:Liver / Q000378:metabolism / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D018962:Phlebotomy; D012372:ROC Curve; D012044:Regression Analysis; D012189:Retrospective Studies