title: Outcome of early vs. deferred antiviral treatment for recurrent hepatitis C in liver transplant recipients.
abstract: The optimal timing to treat recurrent hepatitis-C virus (HCV) after liver transplantation (LT) remains uncertain. We compared the outcome of early (acute phase) and deferred (chronic phase) antiviral treatment for recurrent HCV infection in this population. Consecutive HCV genotype-1 infected LT patients receiving antiviral therapy between 2001-2010 were retrospectively classified according to histology at treatment start into the early or deferred treatment group. Measured endpoints included sustained virological response (SVR) rates and long-term survival. The study cohort comprised 105 patients: 60 (57%) received early treatment (ET) and 45 (43%) deferred treatment (DT). The median interval from LT to antiviral start was 3 (1-9) and 18 months (11-74) in ET and DT respectively. The SVR rate was similar in both treatment groups (23% ET and 36% DT; p = 0.27). After a median follow-up of 5.8 years, all-cause and liver-related mortality were similar in both groups. Variables independently associated with mortality included pre-treatment bilirubin > 2 mg/dL (HR 6.1, 95%CI: 2.8-13.7; p < 0.001), donor age > 60 (HR 3.1, 95%CI: 1.4-6.7; p = 0.01), and failure to achieve SVR (HR 10.3, 95%CI: 1.3-18.3; p = 0.03). In conclusion, early treatment of recurrent HCV is safe, but does not lead to higher SVR rates. In HCV-infected LT recipients, elevated bilirubin, older donor age, and failure to achieve SVR are independently associated with increased mortality.
authors.affiliation: Liver Unit, Department of Internal Medicine, Universitat Autònoma de Barcelona. Barcelona, Spain.
authors.forename: Isabel
authors.initials: I
authors.lastname: Campos-Varela
authors.affiliation: Liver Unit, Department of Internal Medicine, Universitat Autònoma de Barcelona. Barcelona, Spain.
authors.forename: Juan Ignacio
authors.initials: JI
authors.lastname: Esteban
authors.affiliation: Marta Bes Transfusion Safety Laboratory, Banc de Sang i Teixits (BST), Universitat Autònoma de Barcelona. Barcelona, Spain.
authors.forename: Marta
authors.initials: M
authors.lastname: Bes
authors.affiliation: Liver Transplant Unit, Department of HPB-Surgery and Transplant, Universitat Autònoma de Barcelona. Barcelona, Spain.
authors.forename: Cristina
authors.initials: C
authors.lastname: Dopazo
authors.affiliation: Pathology Department, Universitat Autònoma de Barcelona. Barcelona, Spain.
authors.forename: Helena
authors.initials: H
authors.lastname: Allende
authors.affiliation: Biochemistry Laboratory. Hospital Universitari Vall d'Hebron, Institut de Recerca (VHIR), Universitat Autònoma de Barcelona. Barcelona, Spain.
authors.forename: Francisco
authors.initials: F
authors.lastname: Rodríguez-Frías
authors.affiliation: María Teresa Salcedo Pathology Department, Universitat Autònoma de Barcelona. Barcelona, Spain.
authors.forename: María Teresa
authors.initials: MT
authors.lastname: Salcedo
authors.affiliation: Transfusion Safety Laboratory, Banc de Sang i Teixits (BST), Universitat Autònoma de Barcelona. Barcelona, Spain.
authors.forename: Silvia
authors.initials: S
authors.lastname: Sauleda
authors.affiliation: Liver Transplant Unit, Department of HPB-Surgery and Transplant, Universitat Autònoma de Barcelona. Barcelona, Spain.
authors.forename: Ramón
authors.initials: R
authors.lastname: Charco
authors.affiliation: Liver Unit, Department of Internal Medicine, Universitat Autònoma de Barcelona. Barcelona, Spain.
authors.forename: Jaime
authors.initials: J
authors.lastname: Guardia
authors.affiliation: Liver Unit, Department of Internal Medicine, Universitat Autònoma de Barcelona. Barcelona, Spain.
authors.forename: Rafael
authors.initials: R
authors.lastname: Esteban
authors.affiliation: Liver Unit, Department of Internal Medicine, Universitat Autònoma de Barcelona. Barcelona, Spain.
authors.forename: Lluis
authors.initials: L
authors.lastname: Castells
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000998:Antiviral Agents / Q000008:administration & dosage* / Q000627:therapeutic use*; D015331:Cohort Studies; D004334:Drug Administration Schedule; D005260:Female; D005500:Follow-Up Studies; D005838:Genotype; D016174:Hepacivirus / Q000235:genetics; D019698:Hepatitis C, Chronic / Q000188:drug therapy* / Q000401:mortality / Q000601:surgery*; D006801:Humans; D053208:Kaplan-Meier Estimate; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012008:Recurrence; D012189:Retrospective Studies; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000998:Antiviral Agents