title: Liver Support With Albumin Dialysis Reduces Hepatitis C Virus Viremia and Facilitates Antiviral Treatment of Severe Hepatitis C Virus Recurrence After Liver Transplantation.
abstract: Patients with severe hepatitis C virus (HCV) recurrence after liver transplantation (LT) present an ominous prognosis, rarely achieving sustained virological response (SVR). Dialysis procedures may transiently decrease the HCV viral load, but the effect of albumin dialysis is currently unknown. Here, we evaluated the impact of albumin dialysis using the Molecular Adsorbent Recirculating System (MARS) used as a co-adjuvant antiviral treatment for severe HCV recurrence after LT. Thirteen patients (11 males, median age 48 years) with fibrosing cholestatic hepatitis or METAVIR fibrosis score ≥ F3 with severe portal hypertension underwent three consecutive MARS sessions. Antiviral therapy was initiated in 11 patients within 24 h after the MARS sessions. A contemporary cohort of seven patients who did not follow the MARS protocol is shown for comparison. MARS treatment resulted in consistent decreases of viral load from 7.59 log10 IU/mL [6.15-8.90] to 6.79 log10 IU/mL [5.18-7.84] (P = 0.003) as well as in decreases of serum bilirubin, gamma-glutamyl transpeptidase, alanine aminotransferase and aspartate aminotransferase (all P < 0.05). The overall rate of SVR was 0% in the Control group and 54.6% in patients initiating antiviral therapy within 24 h after MARS. Survival at 1 and 3 years was, respectively, 93% and 70% in patients undergoing MARS, compared with 29% and 14% in the Control group (P = 0.001). No major adverse events related to MARS treatment were observed. In conclusion, the use of MARS may facilitate the achievement of SVR and improve the prognosis of patients with severe HCV-recurrence after LT by reducing viral load and improving liver function prior to antiviral therapy.
authors.affiliation: Unidad de Hepatología, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain.
authors.forename: Luis
authors.initials: L
authors.lastname: Ibáñez-Samaniego
authors.affiliation: Unidad de Hepatología, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain.|CIBERehd, Instituto de Salud Carlos III, Madrid, Spain.
authors.forename: María-Vega
authors.initials: MV
authors.lastname: Catalina
authors.affiliation: Unidad de Hepatología, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain.|CIBERehd, Instituto de Salud Carlos III, Madrid, Spain.
authors.forename: Diego
authors.initials: D
authors.lastname: Rincón
authors.affiliation: Servicio de Gastroenterología, Hospital del Tajo, Aranjuez, Madrid, Spain.
authors.forename: Oreste
authors.initials: O
authors.lastname: Lo Iacono
authors.affiliation: Unidad de Hepatología, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain.
authors.forename: Ainhoa
authors.initials: A
authors.lastname: Fernández
authors.affiliation: Unidad de Hepatología, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain.|CIBERehd, Instituto de Salud Carlos III, Madrid, Spain.
authors.forename: Gerardo
authors.initials: G
authors.lastname: Clemente
authors.affiliation: Unidad de Hepatología, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain.|CIBERehd, Instituto de Salud Carlos III, Madrid, Spain.|Facultad de Medicina, Universidad Complutense, Madrid, Spain.
authors.forename: Rafael
authors.initials: R
authors.lastname: Bañares
authors.affiliation: Unidad de Hepatología, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain.|CIBERehd, Instituto de Salud Carlos III, Madrid, Spain.
authors.forename: Javier
authors.initials: J
authors.lastname: Vaquero
authors.affiliation: Unidad de Hepatología, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain.|CIBERehd, Instituto de Salud Carlos III, Madrid, Spain.
authors.forename: Magdalena
authors.initials: M
authors.lastname: Salcedo
mesh_terms: D000418:Albumins / Q000378:metabolism; D000998:Antiviral Agents / Q000627:therapeutic use; D003131:Combined Modality Therapy; D005260:Female; D016174:Hepacivirus / Q000302:isolation & purification; D006526:Hepatitis C / Q000628:therapy* / Q000821:virology; D006801:Humans; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D011379:Prognosis; D012008:Recurrence; D006435:Renal Dialysis / Q000379:methods*; D015996:Survival Rate; D013997:Time Factors; D019562:Viral Load; D014766:Viremia / Q000628:therapy* / Q000821:virology
chemical_list: D000418:Albumins; D000998:Antiviral Agents
keywords: Advanced fibrosis; Antiviral treatment; Fibrosing cholestatic hepatitis; Sustained virological response; Viral load