title: Sirolimus has a potential to influent viral recurrence in HCV positive liver transplant candidates.
abstract: There is in vitro proof that mTOR proteins play a role in protecting HCV infected cells from apoptosis. The aim of this cohort study was to evaluate the effect of sirolimus as an mTOR inhibitor on hepatitis C recurrence in liver transplant recipients. Hepatitis C virus positive patients were followed prospectively regarding transaminases, immunosuppressive target levels, HCV RNA and influence of donor and recipient factors on viral recurrence and survival. Viral recurrence was defined as elevated liver enzymes combined with active hepatitis diagnosed on the basis of increasing viral load and/or biopsy-proven HCV relapse in the transplanted organ. Sixty-seven HCV positive patients were included: 39 received a regimen including sirolimus; 28 patients received calcineurin inhibitors. Sirolimus patients showed a significant decrease in the HCV PCR levels (p<0.05). Survival of the sirolimus patients was significantly higher (p<0.03) than in the other patient cohort. Sirolimus has been shown to be a potent immunosuppressive agent after liver transplantation, though nothing is known about its effect on HCV. This analysis suggests that sirolimus has potential to suppress viral recurrence in HCV positive liver transplant candidates.
authors.affiliation: Department of Surgery, Division of Transplantation Surgery, Medical University Graz, Auenbruggerplatz 29, 8036 Graz, Austria. doris.wagner@medunigraz.at
authors.forename: Doris
authors.initials: D
authors.lastname: Wagner
authors.forename: Daniela
authors.initials: D
authors.lastname: Kniepeiss
authors.forename: Silvia
authors.initials: S
authors.lastname: Schaffellner
authors.forename: Estrella
authors.initials: E
authors.lastname: Jakoby
authors.forename: Helmut
authors.initials: H
authors.lastname: Mueller
authors.forename: Astrid
authors.initials: A
authors.lastname: Fahrleitner-Pammer
authors.forename: Philipp
authors.initials: P
authors.lastname: Stiegler
authors.forename: Karl-Heinz
authors.initials: KH
authors.lastname: Tscheliessnigg
authors.forename: Florian
authors.initials: F
authors.lastname: Iberer
mesh_terms: D015331:Cohort Studies; D005500:Follow-Up Studies; D016174:Hepacivirus / Q000502:physiology*; D006525:Hepatitis, Viral, Human / Q000276:immunology / Q000401:mortality / Q000473:pathology / Q000503:physiopathology / Q000628:therapy*; D006801:Humans; D008099:Liver / Q000187:drug effects* / Q000276:immunology / Q000378:metabolism / Q000473:pathology / Q000821:virology; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D020123:Sirolimus / Q000008:administration & dosage*; D016019:Survival Analysis; D000637:Transaminases / Q000235:genetics / Q000378:metabolism; D019562:Viral Load / Q000187:drug effects; D014775:Virus Activation / Q000187:drug effects; D014779:Virus Replication / Q000187:drug effects; D014850:Waiting Lists
chemical_list: D000637:Transaminases; D020123:Sirolimus