Long-term evaluation of partial splenic embolization followed by interferon therapy in patients with hepatitis C virus (HCV) cirrhosis and thrombocytopenia.
OBJECTIVE
Patients with hepatitis C virus (HCV) cirrhosis and thrombocytopenia are often excluded from receiving interferon therapy because the treatment results in severe platelet depletion. Surgical splenectomy or partial splenic embolization (PSE) is a promising procedure for increasing the platelet count before interferon therapy. We performed PSE and evaluated the long-term clinical course in HCV cirrhotic patients.


METHODS
Patients with HCV cirrhosis and thrombocytopenia were included (n=108) in this study. The straight-coiled PSE procedure (Takatsuka method) was performed. The platelet count, hemodynamic changes, rate of a sustained virological response (SVR) and prevalence of hepatocellular carcinoma (HCC) were evaluated.


RESULTS
PSE resulted in a significant increase in the platelet count (before PSE: 7.9±2.3×10(4)/μL, two weeks after PSE: 16.7±6.6×10(4)/μL (p<0.001). Therefore, all participants were started on regular-dose interferon therapy. The SVR rate was 24% for serotype 1 and 62% for serotype 2. In the biochemical responders (BR) with SVR, the overall survival rate was 94.6% over five years and 89.3% over 10 years. In the non-responders (NR), the overall survival rate was 78.7% over five years and 62.2% over 10 years. The overall survival rate of the patients with SVR+BR was significantly higher than that observed in the patients with NR (p=0.0082). There were no differences in the prevalence of HCC between the patients with SVR+BR and NR.


CONCLUSIONS
PSE enabled the induction of regular-dose interferon therapy in patients with HCV cirrhosis and thrombocytopenia. Although the prevalence of HCC did not differ between the SVR+BR and NR patients, there was a significant survival benefit in the patients with SVR+BR.
Center for Digestive and Liver Disease, Ofuna Chuo Hospital, Japan.
Hirohito
H
Shimizu
Kentaro
K
Takatsuka
Hiroyasu
H
Nakano
Takanori
T
Tenjin
Tomoaki
T
Fujikawa
Atsushi
A
Yoshida
Eiki
E
Yoshimatsu
Keiji
K
Matsui
Shogo
S
Iwabuchi
D000998:Antiviral Agents / Q000008:administration & dosage; D004621:Embolization, Therapeutic / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D016174:Hepacivirus; D019698:Hepatitis C, Chronic / Q000150:complications / Q000628:therapy*; D006801:Humans; D007167:Immunotherapy; D016898:Interferon-alpha / Q000008:administration & dosage*; D008103:Liver Cirrhosis / Q000209:etiology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D010976:Platelet Count; D013154:Spleen / Q000098:blood supply*; D013156:Splenectomy / Q000379:methods; D013921:Thrombocytopenia / Q000097:blood / Q000209:etiology / Q000628:therapy*; D013997:Time Factors; D016896:Treatment Outcome
D000998:Antiviral Agents; D016898:Interferon-alpha