title: Pretransplant serum hepatitis C virus RNA levels predict response to antiviral treatment after living donor liver transplantation.
abstract: BACKGROUND
  Given the limited efficacy and high adverse event rate associated with treatment of recurrent hepatitis C after liver transplantation, an individualized treatment strategy should be considered. The aim of this study was to identify predictors of response to antiviral therapy for hepatitis C after living donor liver transplantation (LDLT) and to study the associated adverse events.
  
  
  METHODS
  A retrospective chart review was performed on 125 hepatitis C virus (HCV)-positive LDLT recipients who received interferon plus ribavirin and/or peginterferon plus ribavirin therapy at Kyoto University between January 2001 and June 2011.
  
  
  RESULTS
  Serum HCV RNA reached undetectable levels within 48 weeks in 77 (62%) of 125 patients, and these patients were defined as showing virological response (VR). Of 117 patients, 50 (43%) achieved sustained VR (SVR). Predictive factors associated with both VR and SVR by univariate analysis included low pretransplant serum HCV RNA levels, a non-1 HCV genotype, and low pretreatment serum HCV RNA levels. In addition, LDLT from ABO-mismatched donors was significantly associated with VR, and white cell and neutrophil counts before interferon therapy were associated with SVR. Multivariate analysis showed that 2 variables-pretransplant serum HCV RNA level less than 500 kIU/mL and a non-1 HCV genotype-remained in models of both VR and SVR and that an ABO mismatch was associated with VR. No variables with a significant effect on treatment withdrawal were found.
  
  
  CONCLUSIONS
  Virological response to antiviral therapy in patients with hepatitis C recurring after LDLT can be predicted prior to transplant, based on pretransplant serum HCV-RNA levels and HCV genotype. LDLT from ABO-mismatched donors may contribute to more efficacious interferon therapy.
  
  
  BACKGROUND
  UMIN-CTR UMIN000003286.
authors.affiliation: Department of Gastroenterology and Hepatology, Graduate School of Medicine, Kyoto University, Kyoto, Japan. yueda@kuhp.kyoto-u.ac.jp
authors.forename: Yoshihide
authors.initials: Y
authors.lastname: Ueda
authors.forename: Toshimi
authors.initials: T
authors.lastname: Kaido
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Ogura
authors.forename: Kohei
authors.initials: K
authors.lastname: Ogawa
authors.forename: Atsushi
authors.initials: A
authors.lastname: Yoshizawa
authors.forename: Koichiro
authors.initials: K
authors.lastname: Hata
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Fujimoto
authors.forename: Aya
authors.initials: A
authors.lastname: Miyagawa-Hayashino
authors.forename: Hironori
authors.initials: H
authors.lastname: Haga
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Marusawa
authors.forename: Satoshi
authors.initials: S
authors.lastname: Teramukai
authors.forename: Shinji
authors.initials: S
authors.lastname: Uemoto
authors.forename: Tsutomu
authors.initials: T
authors.lastname: Chiba
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D019943:Amino Acid Substitution; D000998:Antiviral Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D005260:Female; D005838:Genotype; D016174:Hepacivirus / Q000235:genetics; D019698:Hepatitis C, Chronic / Q000188:drug therapy* / Q000601:surgery / Q000821:virology*; D006801:Humans; D016898:Interferon-alpha / Q000008:administration & dosage / Q000627:therapeutic use; D016031:Liver Transplantation; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D016896:Treatment Outcome; D014758:Viral Core Proteins / Q000737:chemistry / Q000235:genetics; D019562:Viral Load; D028761:Withholding Treatment; D055815:Young Adult
chemical_list: D000998:Antiviral Agents; D016898:Interferon-alpha; D014758:Viral Core Proteins