title: Splenectomy prior to antiviral therapy in patients with hepatitis C virus related decompensated cirrhosis.
abstract: Patients with hepatitis C virus-related decompensated cirrhosis can benefit from interferon-based antiviral therapy, but the common complication of cytopenia is a contraindication for this treatment. Splenectomy prior to interferon therapy may alleviate this problem. To investigate whether splenectomy improves the efficacy of antiviral therapy, 13 interferon-naïve hepatitis C virus decompensated cirrhotic patients underwent splenectomy between January 2008 and January 2011, followed 1-3 months later by an interferon-based therapeutic regimen (pegylated/standard interferon-α combined with ribavirin for 48 weeks). Ten (76.9%) of the patients developed postoperative complications, which included minor portal vein thrombosis (2/13, 15.4%) and transient ascites (8/13, 61.5%). At one-month post-splenectomy, the patients showed significantly increased platelet (pre-surgery: 48.2±15.9 vs. 186.0±70.6×10(3)μL(-1), p<0.001) and leukocyte (2.1±0.5 vs. 5.7±1.4×10(3)μL(-1), p<0.001) counts. Eight (61.5%) of the patients achieved sustained virological response, including all HCV genotype 2a-infected patients (4/4, 100%) and some of the genotype 1b-infected patients (4/9, 44.4%). Temporary interferon-α suspension was required for one patient to address severe intestinal infection. These results indicate that splenectomy prior to interferon-based therapy was safe and may facilitate adherence to subsequent antiviral therapy in selected HCV cirrhotic patients with portal hypertension and hypersplenism.
authors.affiliation: Department of Hepatology and Surgery, College of Medicine, Xi'an Jiaotong University, Shaanxi Province, China; Department of Infectious Disease, College of Medicine, Xi'an Jiaotong University, Shaanxi Province, China.
authors.forename: Fanpu
authors.initials: F
authors.lastname: Ji
authors.forename: Shu
authors.initials: S
authors.lastname: Zhang
authors.forename: Na
authors.initials: N
authors.lastname: Huang
authors.forename: Hong
authors.initials: H
authors.lastname: Deng
authors.forename: Zongfang
authors.initials: Z
authors.lastname: Li
mesh_terms: D000328:Adult; D000998:Antiviral Agents / Q000008:administration & dosage; D005260:Female; D005838:Genotype; D019698:Hepatitis C, Chronic / Q000150:complications / Q000188:drug therapy / Q000601:surgery*; D006801:Humans; D016898:Interferon-alpha / Q000008:administration & dosage; D008103:Liver Cirrhosis / Q000188:drug therapy / Q000821:virology*; D008297:Male; D008875:Middle Aged; D012254:Ribavirin / Q000008:administration & dosage; D013156:Splenectomy; D016896:Treatment Outcome
chemical_list: D000998:Antiviral Agents; D016898:Interferon-alpha; D012254:Ribavirin
keywords: Antiviral therapy; Hepatitis C virus; Splenectomy; Thrombocytopenia