title: Genotype 3 and higher low-density lipoprotein levels are predictors of good response to treatment of recurrent hepatitis C following living donor liver transplantation.
abstract: BACKGROUND
  Treatment of recurrent hepatitis C after liver transplantation is associated with poor sustained virological response (SVR) in genotype 1, and data on genotype 3 is limited to small numbers. We report one of the largest series of genotype 3 patients treated for recurrent hepatitis C following living donor liver transplantation (LDLT).
  
  
  METHODS
  From January 2002 to November 2013, of 1349 transplants, 359 patients had hepatitis C. Patients with histological recurrence were treated with pegylated interferon in escalating dose regimen for 48 weeks and weight-based ribavirin. Virological response was defined as rapid virological response (RVR-4 weeks), early virological response (EVR-12 weeks), end of treatment response (ETR-48 weeks), and SVR (24 weeks after end of treatment). SVR and no-SVR groups were compared for age, sex, body mass index (BMI), diabetes, total cholesterol, low-density lipoprotein (LDL), high-density lipoprotein (HDL), triglycerides, ferritin, genotype, and hepatitis C virus (HCV) RNA levels before initiation of treatment.
  
  
  RESULTS
  The study included 67 patients who had at least 18 months of follow up after treatment initiation (45 males), aged 51 ± 6.3 years. Treatment was started after 16 months (median); baseline median RNA was 2.7 × 10(6) IU/mL. There was no significant difference between the SVR and no-SVR groups regarding age, sex ratio, follow up period, total cholesterol, triglycerides, HDL, BMI, prevalence of diabetes, HCV RNA, and ferritin levels. Genotype 3, RVR, EVR, ETR, and higher LDL levels were significantly associated with SVR. Genotype 3 had a significantly higher SVR rate of 71 % as compared to an SVR rate of only 14 % in genotype 1, p = 0.0003. Absence of RVR and EVR predicted treatment failure with a specificity of 88 % and 92 %, respectively.
  
  
  CONCLUSIONS
  Genotype 3 and higher LDL levels predict SVR in patients treated for hepatitis C recurrence following LDLT, whereas absence of RVR and EVR strongly predict treatment failure.
authors.affiliation: Medanta Liver Institute, Gurgaon, Haryana, 122 001, India. sanjivsaigal@hotmail.com.
authors.forename: Sanjiv
authors.initials: S
authors.lastname: Saigal
authors.affiliation: Medanta Liver Institute, Gurgaon, Haryana, 122 001, India.
authors.forename: Narendra S
authors.initials: NS
authors.lastname: Choudhary
authors.affiliation: Medanta Liver Institute, Gurgaon, Haryana, 122 001, India.
authors.forename: Neeraj
authors.initials: N
authors.lastname: Saraf
authors.affiliation: Department of Histopathology, Medanta The Medicity, Gurgaon, Haryana, 122 001, India.
authors.forename: Dheeraj
authors.initials: D
authors.lastname: Gautam
authors.affiliation: Department of Histopathology, Medanta The Medicity, Gurgaon, Haryana, 122 001, India.
authors.forename: Lipika
authors.initials: L
authors.lastname: Lipi
authors.affiliation: Medanta Liver Institute, Gurgaon, Haryana, 122 001, India.
authors.forename: Amit
authors.initials: A
authors.lastname: Rastogi
authors.affiliation: Medanta Liver Institute, Gurgaon, Haryana, 122 001, India.
authors.forename: Sanjay
authors.initials: S
authors.lastname: Goja
authors.affiliation: Medanta Liver Institute, Gurgaon, Haryana, 122 001, India.
authors.forename: P Balachandran
authors.initials: PB
authors.lastname: Menon
authors.affiliation: Medanta Liver Institute, Gurgaon, Haryana, 122 001, India.
authors.forename: Prashant
authors.initials: P
authors.lastname: Bhangui
authors.affiliation: Medanta Liver Institute, Gurgaon, Haryana, 122 001, India.
authors.forename: Sumana K
authors.initials: SK
authors.lastname: Ramachandra
authors.affiliation: Medanta Liver Institute, Gurgaon, Haryana, 122 001, India.
authors.forename: Arvinder S
authors.initials: AS
authors.lastname: Soin
mesh_terms: D000998:Antiviral Agents / Q000008:administration & dosage; D005260:Female; D005500:Follow-Up Studies; D005544:Forecasting; D005838:Genotype; D006526:Hepatitis C / Q000235:genetics* / Q000628:therapy / Q000821:virology*; D006801:Humans; D016898:Interferon-alpha / Q000008:administration & dosage; D008077:Lipoproteins, LDL / Q000097:blood*; D016031:Liver Transplantation; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D012254:Ribavirin / Q000008:administration & dosage; D013997:Time Factors; D017211:Treatment Failure; D016896:Treatment Outcome
chemical_list: D000998:Antiviral Agents; D016898:Interferon-alpha; D008077:Lipoproteins, LDL; D012254:Ribavirin
keywords: Hepatitis C virus; Liver transplantation; Sustained virological response