title: Early and extended therapy for recurrent hepatitis C after liver transplantation.
abstract: BACKGROUND
  End-stage cirrhosis due to hepatitis C virus (HCV) is one of the most common indications for orthotopic liver transplantation (OLT). Recurrence is universal and more aggressive than before OLT. The aim of this study was to evaluate the efficacy and tolerability of antiviral therapy in recurrent HCV after OLT. Therapy was started even with mild fibrosis (F < 2) and extended until 72 weeks, if it was possible.
  
  
  METHODS
  Between November 2001 and December 2010, 279 OLTs were performed in 262 patients in our hospital; 81 (31%) for HCV-related cirrhosis. Nineteen patients were excluded because they died in the first 6 months. We treated 28 of 62 HVC patients.
  
  
  RESULTS
  Twenty-eight patients met the indication for antiviral therapy: 21 male (75%) and 7 female (25%), with a mean age of 56 years (range, 40 to 68 years). All the patients had histologically proven recurrence liver disease: F1, 19 patients (68%); F2, 4 patients (14%), and F3, 45 patients (18%). The mean time to recurrence was 23 months, with a range of 3 to 90 months. Adverse effects (leukopenia in 82% and anemia in 79%) were treated with granulocyte colony-stimulating factor (GCSF) and erythropoietin (EPO), and dose reduction. Four patients (14%) were withdrawn from the treatment because of adverse effects. Nineteen patients achieved early virologic response (68%), and the sustained virologic response was 54% (15 of 28 patients). Five patients died (18%).
  
  
  CONCLUSIONS
  Improving sustained virologic response in HCV liver transplant patients is a key goal. Antiviral therapy is safe and effective treating HCV recurrence after OLT. Starting this therapy in an early stage of hepatitis C recurrence, extending antiviral therapy (72 weeks), and avoiding dose reduction of antiviral drugs could help to achieve higher rates of sustained virological response.
authors: Liver Transplantation Unit, Hepatology Unit, Hospital Universitario Rio Hortega, Valladolid, Spain. fgarciapa@saludcastillayleon.es
authors: F
authors: F
authors: García-Pajares
authors: C
authors: C
authors: Almohalla
authors: S
authors: S
authors: Lorenzo Pelayo
authors: R
authors: R
authors: Ruiz Zorrilla
authors: P
authors: P
authors: Pinto
authors: C
authors: C
authors: Ramos
authors: G
authors: G
authors: Sanchez Antolin
authors: A C
authors: AC
authors: Paton
mesh_terms: D000328:Adult; D000368:Aged; D000998:Antiviral Agents / Q000008:administration & dosage* / Q000009:adverse effects; D004334:Drug Administration Schedule; D005260:Female; D006526:Hepatitis C / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy* / Q000401:mortality; D006801:Humans; D016898:Interferon-alpha / Q000008:administration & dosage* / Q000009:adverse effects; D008103:Liver Cirrhosis / Q000175:diagnosis / Q000401:mortality / Q000601:surgery* / Q000821:virology; D016031:Liver Transplantation / Q000009:adverse effects* / Q000401:mortality; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011092:Polyethylene Glycols / Q000008:administration & dosage* / Q000009:adverse effects; D011994:Recombinant Proteins / Q000008:administration & dosage / Q000009:adverse effects; D012008:Recurrence; D012254:Ribavirin / Q000008:administration & dosage* / Q000009:adverse effects; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D013030:Spain; D013997:Time Factors; D016896:Treatment Outcome; D014775:Virus Activation
chemical_list: D000998:Antiviral Agents; D016898:Interferon-alpha; D011994:Recombinant Proteins; D011092:Polyethylene Glycols; D012254:Ribavirin; C100416:peginterferon alfa-2a