title: Management of hepatitis C virus infection in liver transplantation with adacolumn apheresis.
abstract: Recurrent hepatitis C virus (HCV) is a major cause of liver transplant loss, hepatic failure, and retransplantation need. Posttransplantation antiviral therapy in patients with evidence of recurrent disease is the mainstay of management. Although HCV is a hepatocellular pathogen, there is increasing evidence that the virus can infect and persist in other cells. In particular, granulocytes and monocytes/macrophages are known to constitute extrahepatic sites for HCV replication and dissemination. The aim of this study was to apply Adacolumn apheresis as a possible therapeutic alternative to conventional drug therapy to manage HCV infections. Seven patients who underwent liver transplantation for HCV-related cirrhosis were eligible for the study. The patients underwent 5 1-hour sessions for 5 consecutive days. The first treatment was performed in the anhepatic phase of liver transplantation with the intent to early reduce infected granulocytes and monocytes/macrophages. The patients were evaluated over the 5 days after inclusion with 3- and 6-months follow-ups. Early apheresis treatments in the anhepatic phase and over the following 4 days after transplantation produced low viral loads in 4 patients, negative viral loads in 2 patients, and increased viremia in 1 patient. At follow-up, the viremia load was stable in 6 patients without increased transaminase levels. At the end of the treatment cycle, almost all immune cells of the 6 patients maintained CD4+/CD8+ T-cell ratios. The optimal timing of treatment initiation is unknown, but early preemptive therapy is recommended to decrease the risk for recurrent infection. Although this study investigated the responses among a small number of patients, it documented that the Adacolumn changed cellular immunity, promoting early virologic responses.
authors.affiliation: Department P. Stefanini of General Surgery and Organs Transplant, Sapienza University, Rome, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Novelli
authors.forename: M
authors.initials: M
authors.lastname: Rossi
authors.forename: V
authors.initials: V
authors.lastname: Morabito
authors.forename: G
authors.initials: G
authors.lastname: Ferretti
authors.forename: R
authors.initials: R
authors.lastname: Pretagostini
authors.forename: F
authors.initials: F
authors.lastname: Ruberto
authors.forename: F
authors.initials: F
authors.lastname: Pugliese
authors.forename: N
authors.initials: N
authors.lastname: Guglielmo
authors.forename: P B
authors.initials: PB
authors.lastname: Berloco
mesh_terms: D016174:Hepacivirus / Q000502:physiology; D006526:Hepatitis C / Q000601:surgery*; D006801:Humans; D016031:Liver Transplantation; D014779:Virus Replication