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Zanaga LP, Vigani AG, Angerami RN, Giorgetti A, Escanhoela CAF, Ataíde EC, Boin IFSF, Stucchi RSB. Survival benefits of interferon-based therapy in patients with recurrent hepatitis C after orthotopic liver transplantation. ACTA ACUST UNITED AC 2017; 50:e5540. [PMID: 28076451 PMCID: PMC5264534 DOI: 10.1590/1414-431x20165540] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Accepted: 11/01/2016] [Indexed: 12/13/2022]
Abstract
Recurrent hepatitis C after orthotopic liver transplantation (OLT) is universal and
can lead to graft failure and, consequently, reduced survival. Hepatitis C treatment
can be used to prevent these detrimental outcomes. The aim of this study was to
describe rates of hepatitis C recurrence and sustained virological response (SVR) to
interferon-based treatment after OLT and its relationship to survival and progression
of liver disease through retrospective analysis of medical records of 127 patients
who underwent OLT due to cirrhosis or hepatocellular carcinoma secondary to chronic
hepatitis C between January 2002 and December 2013. Fifty-six patients were diagnosed
with recurrent disease, 42 started interferon-based therapy and 37 completed
treatment. Demographic, treatment- and outcome-related variables were compared
between SVR and non-responders (non-SVR). There was an overall 54.1% SVR rate with
interferon-based therapies. SVR was associated with longer follow-up after treatment
(median 66.5 vs 37 months for non-SVR, P=0.03) and after OLT (median
105 vs 72 months, P=0.074), and lower rates of disease progression
(15 vs 64.7%, P=0.0028) and death (5 vs 35.3%,
P=0.033). Regardless of the result of therapy (SVR or non-SVR), there was a
significant difference between treated and untreated patients regarding the
occurrence of death (P<0.001) and months of survival (P<0.001). Even with
suboptimal interferon-based therapies (compared to the new direct-acting antivirals)
there is a 54.1% SVR rate to treatment. SVR is associated with improved survival and
reduced risks of clinical decompensation, loss of the liver graft and death.
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Affiliation(s)
- L P Zanaga
- Disciplina de Infectologia, Departamento de Clínica Médica, Faculdade de Ciências Médicas, Universidade Estadual de Campinas, Campinas, SP, Brasil
| | - A G Vigani
- Disciplina de Infectologia, Departamento de Clínica Médica, Faculdade de Ciências Médicas, Universidade Estadual de Campinas, Campinas, SP, Brasil
| | - R N Angerami
- Disciplina de Infectologia, Departamento de Clínica Médica, Faculdade de Ciências Médicas, Universidade Estadual de Campinas, Campinas, SP, Brasil
| | - A Giorgetti
- Disciplina de Infectologia, Departamento de Clínica Médica, Faculdade de Ciências Médicas, Universidade Estadual de Campinas, Campinas, SP, Brasil
| | - C A F Escanhoela
- Departamento de Anatomia Patológica, Faculdade de Ciências Médicas, Universidade Estadual de Campinas, Campinas, SP, Brasil
| | - E C Ataíde
- Unidade de Transplante de Fígado, Departamento de Cirurgia, Faculdade de Ciências Médicas, Universidade Estadual de Campinas, Campinas, SP, Brasil
| | - I F S F Boin
- Unidade de Transplante de Fígado, Departamento de Cirurgia, Faculdade de Ciências Médicas, Universidade Estadual de Campinas, Campinas, SP, Brasil
| | - R S B Stucchi
- Disciplina de Infectologia, Departamento de Clínica Médica, Faculdade de Ciências Médicas, Universidade Estadual de Campinas, Campinas, SP, Brasil
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Lanini S, Nanni Costa A, Grossi PA, Procaccio F, Ricci A, Capobianchi MR, Terrault NA, Ippolito G. Liver transplant recipients and prioritization of anti-HCV therapy: an Italian cohort analysis. Liver Int 2016; 36:410-7. [PMID: 26264452 PMCID: PMC5317090 DOI: 10.1111/liv.12938] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2015] [Accepted: 08/01/2015] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND AIMS In patients with hepatitis C virus (HCV), recurrence of infection after liver transplant (LT) is universal and associated with worst survival. We present the results of an Italian cohort to compare the 3-year outcome of HCV-Ab-positive and HCV-Ab-negative LT recipients and to assess the potential interaction between HCV-Ab sero-status and other risk factors for LT failure. METHODS The study is a multicentre cohort including a sample of liver transplant centres. Participant's information was collected at the local level. The best functional form of variables was decided according to the objective methods based on information theory. Association between transplant failure and potential risk factors was assessed in univariate and multivariate Poisson regression model with random intercept. RESULTS Between June 2007 and May 2009, 1164 LT recipients were enrolled in 16 Italian transplant centres, of them 275 (23.63%) experienced LT failure. Incidence rates of LT failure was 0.32 and 0.23 per 1000 person-days in HCV-Ab-positive and HCV-Ab-negative recipients respectively (P = 0.003). Inferential models according to Akaike information criterion indicated that donor-recipient age difference and donor-recipient sex matching were more informative to predict LT failure than the age and the sex as separate variables. Multivariate analysis provided evidence that HCV-Ab sero-status, time after LT, donor-recipient age difference, donor-recipient sex matching and recipient's MELD score were significantly associated with LT failure. Moreover, the effect of HCV-Ab sero-status on LT failure was modified by the simultaneous action of time after LT and donor-recipient age difference. No interaction was found between recipient's HCV-Ab sero-status and either recipient's MELD or donor-recipient sex matching. CONCLUSION In view of the imminent introduction of new anti-HCV therapies, our study provides information to assess which LT recipients should be prioritized for receiving these highly effective, but expensive, new treatments. This is particularly relevant for those clinical settings where healthcare prioritization is endorsed by national authorities.
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Affiliation(s)
- Simone Lanini
- ‘Lazzaro Spallanzani’ National Institute for Infectious Diseases IRCCS, Rome, Italy
| | - Alessandro Nanni Costa
- Italian National Transplant Center (CNT), Italian National Institute of Health (ISS), Rome, Italy
| | - Paolo A. Grossi
- Department of Surgical and Morphological Sciences, University of Insubria-Ospedale di Circolo, Varese, Italy
| | - Francesco Procaccio
- Italian National Transplant Center (CNT), Italian National Institute of Health (ISS), Rome, Italy
| | - Andrea Ricci
- Italian National Transplant Center (CNT), Italian National Institute of Health (ISS), Rome, Italy
| | - Maria R. Capobianchi
- ‘Lazzaro Spallanzani’ National Institute for Infectious Diseases IRCCS, Rome, Italy
| | | | - Giuseppe Ippolito
- ‘Lazzaro Spallanzani’ National Institute for Infectious Diseases IRCCS, Rome, Italy
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Hüsing A, Kabar I, Schmidt HH, Heinzow HS. Hepatitis C in Special Patient Cohorts: New Opportunities in Decompensated Liver Cirrhosis, End-Stage Renal Disease and Transplant Medicine. Int J Mol Sci 2015; 16:18033-53. [PMID: 26251895 PMCID: PMC4581234 DOI: 10.3390/ijms160818033] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2015] [Revised: 07/16/2015] [Accepted: 07/27/2015] [Indexed: 12/16/2022] Open
Abstract
Worldwide, hepatitis C virus (HCV) is a common infection. Due to new antiviral approaches and the approval of direct-acting antiviral agents (DAA), HCV therapy has become more comfortable. Nevertheless, there are special patient groups, in whom treatment of HCV is still challenging. Due to only few data available, tolerability and efficacy of DAAs in special patient cohorts still remain unclear. Such special patient cohorts comprise HCV in patients with decompensated liver disease (Child-Pugh Class B or C), patients with chronic kidney disease, and patients on waiting lists to renal/liver transplantation or those with HCV recurrence after liver transplantation. HCV infection in these patient cohorts has been shown to be associated with increased morbidity and mortality and may lead to reduced graft survival after transplantation. Successful eradication of HCV results in a better outcome concerning liver-related complications and in a better clinical outcome of these patients. In this review, we analyze available data and results from recently published literature and provide an overview of current recommendations of HCV-therapy regimen in these special patient cohorts.
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Affiliation(s)
- Anna Hüsing
- Department of Transplant Medicine, University Hospital Muenster, 48149 Münster, Germany.
| | - Iyad Kabar
- Department of Transplant Medicine, University Hospital Muenster, 48149 Münster, Germany.
| | - Hartmut H Schmidt
- Department of Transplant Medicine, University Hospital Muenster, 48149 Münster, Germany.
| | - Hauke S Heinzow
- Department of Transplant Medicine, University Hospital Muenster, 48149 Münster, Germany.
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Grassi A, Ballardini G. Post-liver transplant hepatitis C virus recurrence: an unresolved thorny problem. World J Gastroenterol 2014; 20:11095-115. [PMID: 25170198 PMCID: PMC4145752 DOI: 10.3748/wjg.v20.i32.11095] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2013] [Revised: 02/15/2014] [Accepted: 05/29/2014] [Indexed: 02/06/2023] Open
Abstract
Hepatitis C virus (HCV)-related cirrhosis represents the leading cause of liver transplantation in developed, Western and Eastern countries. Unfortunately, liver transplantation does not cure recipient HCV infection: reinfection universally occurs and disease progression is faster after liver transplant. In this review we focus on what happens throughout the peri-transplant phase and in the first 6-12 mo after transplantation: during this crucial period a completely new balance between HCV, liver graft, the recipient's immune response and anti-rejection therapy is achieved that will deeply affect subsequent outcomes. Nearly all patients show an early graft reinfection, with HCV viremia reaching and exceeding pre-transplant levels; in this setting, histological assessment is essential to differentiate recurrent hepatitis C from acute or chronic rejection; however, differentiating the two patterns remains difficult. The host immune response (mainly cellular mediated) appears to be crucial both in the control of HCV infection and in the genesis of rejection, and it is also strongly influenced by immunosuppressive treatment. At present no clear immunosuppressive strategy could be strongly recommended in HCV-positive recipients to prevent HCV recurrence, even immunotherapy appears to be ineffective. Nonetheless it seems reasonable that episodes of rejection and over-immunosuppression are more likely to enhance the risk of HCV recurrence through immunological mechanisms. Both complete prevention of rejection and optimization of immunosuppression should represent the main goals towards reducing the rate of graft HCV reinfection. In conclusion, post-transplant HCV recurrence remains an unresolved, thorny problem because many factors remain obscure and need to be better determined.
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Kim G, Baik SK. Overview and recent trends of systematic reviews and meta-analyses in hepatology. Clin Mol Hepatol 2014; 20:137-50. [PMID: 25032179 PMCID: PMC4099328 DOI: 10.3350/cmh.2014.20.2.137] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2014] [Accepted: 05/29/2014] [Indexed: 12/12/2022] Open
Abstract
A systematic review (SR) is a research methodology that involves a comprehensive search for and analysis of relevant studies on a specific topic. A strict and objective research process is conducted that comprises a systematic and comprehensive literature search in accordance with predetermined inclusion/exclusion criteria, and an assessment of the risk of bias of the selected literature. SRs require a multidisciplinary approach that necessitates cooperation with clinical experts, methodologists, other experts, and statisticians. A meta-analysis (MA) is a statistical method of quantitatively synthesizing data, where possible, from the primary literature selected for the SR. Review articles differ from SRs in that they lack a systematic methodology such as a literature search, selection of studies according to strict criteria, assessment of risk bias, and synthesis of the study results. The importance of evidence-based medicine (EBM) in the decision-making for public policy has recently been increasing thanks to the realization that it should be based on scientific research data. SRs and MAs are essential for EBM strategy and evidence-based clinical practice guidelines. This review addresses the current trends in SRs and MAs in the field of hepatology via a search of recently published articles in the Cochrane Library and Ovid-MEDLINE.
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Affiliation(s)
- Gaeun Kim
- Department of Nursing, Keimyung University College of Nursing, Daegu, Korea
| | - Soon Koo Baik
- Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
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