title: Chronic rejection associated with antiviral therapy for recurrent hepatitis C after living-donor liver transplantation.
abstract: BACKGROUND
  Chronic rejection (CR) has been reported to be associated with antiviral therapy for recurrent hepatitis C in liver transplant (LT) recipients. The aims of this study were to clarify the details of antiviral therapy-associated CR after living-donor liver transplantation (LDLT) and to identify the factors associated with CR.
  
  
  METHODS
  A retrospective chart review was performed on 125 recipients who had received antiviral therapy for recurrent hepatitis C after LDLT between January 2001 and September 2012. The characteristics of patients who developed CR during or within 6 months after antiviral therapy were compared with those of 76 patients who did not develop CR despite receiving antiviral therapy for more than 1 year.
  
  
  RESULTS
  Seven of 125 (6%) patients developed CR during or within 6 months after the end of antiviral therapy. CR was diagnosed after a median (range) of 9 (1-16) months of antiviral therapy. In five patients, rejection progressed rapidly and resulted in death within 3 months after diagnosis. Analysis revealed two significant factors associated with CR: reduction of the immunosuppressant dose during antiviral therapy and a low fibrosis score as the indication for antiviral therapy.
  
  
  CONCLUSIONS
  CR developed in association with antiviral therapy for recurrent hepatitis C after LDLT. This complication may be prevented by ensuring that the immunosuppressant dose is not reduced during antiviral therapy.
authors.affiliation: 1 Department of Gastroenterology and Hepatology, Graduate School of Medicine, Kyoto University, Kyoto, Japan. 2 Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan. 3 Department of Diagnostic Pathology, Graduate School of Medicine, Kyoto University, Kyoto, Japan. 4 Address correspondence to: Yoshihide Ueda, M.D., Ph.D., Department of Gastroenterology and Hepatology, Graduate School of Medicine, Kyoto University, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto 606-8507, Japan.
authors.forename: Yoshihide
authors.initials: Y
authors.lastname: Ueda
authors.forename: Toshimi
authors.initials: T
authors.lastname: Kaido
authors.forename: Takashi
authors.initials: T
authors.lastname: Ito
authors.forename: Kohei
authors.initials: K
authors.lastname: Ogawa
authors.forename: Atsushi
authors.initials: A
authors.lastname: Yoshizawa
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Fujimoto
authors.forename: Akira
authors.initials: A
authors.lastname: Mori
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: Tsutomu
authors.initials: T
authors.lastname: Chiba
authors.forename: Shinji
authors.initials: S
authors.lastname: Uemoto
mesh_terms: D000328:Adult; D000368:Aged; D000998:Antiviral Agents / Q000009:adverse effects* / Q000627:therapeutic use; D005260:Female; D005355:Fibrosis; D006084:Graft Rejection / Q000139:chemically induced*; D006526:Hepatitis C / Q000188:drug therapy* / Q000628:therapy; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D016898:Interferon-alpha / Q000008:administration & dosage; D007372:Interferons / Q000008:administration & dosage; D017093:Liver Failure / Q000401:mortality / Q000628:therapy / Q000821:virology; D016031:Liver Transplantation / Q000379:methods*; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D011092:Polyethylene Glycols / Q000008:administration & dosage; D011994:Recombinant Proteins / Q000008:administration & dosage; D012008:Recurrence; D012189:Retrospective Studies; D012254:Ribavirin / Q000008:administration & dosage; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000998:Antiviral Agents; D007166:Immunosuppressive Agents; D016898:Interferon-alpha; D011994:Recombinant Proteins; D011092:Polyethylene Glycols; D012254:Ribavirin; D007372:Interferons; C100416:peginterferon alfa-2a