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Pacheco LS, Ventura PE, Kist R, Garcia VD, Meinerz G, Tovo CV, Cantisani GPC, Zanotelli ML, Mucenic M, Keitel E. Real-world effectiveness and safety of direct-acting antivirals for the treatment of hepatitis C virus in kidney and liver transplant recipients: experience of a large transplant center in Brazil. Rev Inst Med Trop Sao Paulo 2023; 65:e59. [PMID: 38055377 DOI: 10.1590/s1678-9946202365059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 10/26/2023] [Indexed: 12/08/2023] Open
Abstract
Direct-acting antivirals are the gold-standard treatment for chronic HCV infections, but few studies have investigated their use on kidney and liver transplant recipients. We conducted a real-world study to evaluate the rates of sustained virological response with direct-acting antivirals in kidney and liver transplant recipients. Moreover, it also aimed to evaluate direct-acting antivirals (DAAs) interference with immunosuppressant levels and to describe the frequency of adverse events. As part of this retrospective observational cohort, we included adult patients that had undergone a kidney transplant (KT) or liver transplant (LT) at our center, had a chronic HCV infection, and were treated with DAAs from June 2016 to December 2021. A total of 165 patients were included in the analysis, divided in 108 KT and 57 LT recipients. HCV genotype 1 was more frequent in KT (58.4%), and genotype 3 was more prevalent in LT (57.9%) patients. Sustained virological response was achieved in 89.6% of patients. Adverse effects were reported by 36% of patients. There were significant interactions with immunosuppressants requiring dose adjustments. A total of three episodes of rejection were reported in KT recipients. In conclusion, DAA treatment resulted in high rates of SVR and was well tolerated in both kidney and liver transplant patients. Adverse events were frequent but not severe in most patients, with low treatment drop-out rates. Interactions with immunosuppressants need monitoring since dose adjustments may be required. Reporting real-life experiences is important to help build evidence for patient management in non-controlled environments.
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Affiliation(s)
- Larissa Sgaria Pacheco
- Universidade Federal de Ciências da Saúde de Porto Alegre, Programa de Pós-Graduação em Patologia, Porto Alegre, Rio Grande do Sul, Brazil
- Irmandade da Santa Casa de Misericórdia de Porto Alegre, Departamento de Nefrologia e Transplante de Rim e Pâncreas, Porto Alegre, Rio Grande do Sul, Brazil
| | - Pedro Enrico Ventura
- Irmandade da Santa Casa de Misericórdia de Porto Alegre, Departamento de Nefrologia e Transplante de Rim e Pâncreas, Porto Alegre, Rio Grande do Sul, Brazil
| | - Roger Kist
- Irmandade da Santa Casa de Misericórdia de Porto Alegre, Departamento de Nefrologia e Transplante de Rim e Pâncreas, Porto Alegre, Rio Grande do Sul, Brazil
| | - Valter Duro Garcia
- Irmandade da Santa Casa de Misericórdia de Porto Alegre, Departamento de Nefrologia e Transplante de Rim e Pâncreas, Porto Alegre, Rio Grande do Sul, Brazil
| | - Gisele Meinerz
- Irmandade da Santa Casa de Misericórdia de Porto Alegre, Departamento de Nefrologia e Transplante de Rim e Pâncreas, Porto Alegre, Rio Grande do Sul, Brazil
| | - Cristiane Valle Tovo
- Universidade Federal de Ciências da Saúde de Porto Alegre, Departamento de Medicina Interna, Porto Alegre, Rio Grande do Sul, Brazil
| | - Guido Pio Cracco Cantisani
- Irmandade da Santa Casa de Misericórdia de Porto Alegre, Grupo de Transplante Hepático, Porto Alegre, Rio Grande do Sul, Brazil
| | - Maria Lucia Zanotelli
- Irmandade da Santa Casa de Misericórdia de Porto Alegre, Grupo de Transplante Hepático, Porto Alegre, Rio Grande do Sul, Brazil
| | - Marcos Mucenic
- Universidade Federal de Ciências da Saúde de Porto Alegre, Programa de Pós-Graduação em Patologia, Porto Alegre, Rio Grande do Sul, Brazil
- Irmandade da Santa Casa de Misericórdia de Porto Alegre, Grupo de Transplante Hepático, Porto Alegre, Rio Grande do Sul, Brazil
| | - Elizete Keitel
- Universidade Federal de Ciências da Saúde de Porto Alegre, Programa de Pós-Graduação em Patologia, Porto Alegre, Rio Grande do Sul, Brazil
- Irmandade da Santa Casa de Misericórdia de Porto Alegre, Departamento de Nefrologia e Transplante de Rim e Pâncreas, Porto Alegre, Rio Grande do Sul, Brazil
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Tsai WC, Chiang HC, Chiu YC, Chien SC, Cheng PN, Chiu HC. Chronic Hepatitis C Virus Infection: An Ongoing Challenge in Screening and Treatment. Life (Basel) 2023; 13:1964. [PMID: 37895346 PMCID: PMC10608250 DOI: 10.3390/life13101964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 09/22/2023] [Accepted: 09/23/2023] [Indexed: 10/29/2023] Open
Abstract
With the advent of direct-acting antiviral agents (DAA) in the recent few years, hepatitis C virus (HCV) infection has become a curable infectious disease. Successful clearance of HCV could lead to improvement of both hepatic and extrahepatic outcomes, such as complications of cirrhosis, hepatocellular carcinoma, cardiovascular diseases, and incident diabetes. However, challenges persist in reaching the HCV elimination goals of the World Health Organization by 2030. Among these challenges are identifying those already infected or undiagnosed subjects, re-linking to the care of known but untreated HCV-infected subjects, and developing strategies to enhance treatment rates and compliance in specific or high-risk populations. In addition, issues of post-DAA viral clearance, including avoiding or preventing reinfection in high-risk populations and surveillance of hepatocellular carcinoma, are important to consolidate the treatment's short- and long-term efficacies. In the current DAA era, treatment is the most effective prevention strategy not only in its excellent efficacy and safety but also in preventing HCV spread. All of the surveillance or measures should center on DAA treatment in clinical practice.
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Affiliation(s)
| | | | | | | | - Pin-Nan Cheng
- Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704, Taiwan; (W.-C.T.); (H.-C.C.); (Y.-C.C.); (S.-C.C.)
| | - Hung-Chih Chiu
- Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704, Taiwan; (W.-C.T.); (H.-C.C.); (Y.-C.C.); (S.-C.C.)
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Abstract
Abnormal liver tests are common after liver transplantation. The differential diagnosis depends on the clinical context, particularly the time course, pattern and degree of elevation, and donor and recipient factors. The perioperative period has distinct causes compared with months and years after transplant, including ischemia-reperfusion injury, vascular thrombosis, and primary graft nonfunction. Etiologies seen beyond the perioperative period include biliary complications, rejection, infection, recurrent disease, and non-transplant-specific causes. The evaluation begins with a liver ultrasound with Doppler as well as appropriate laboratory testing and culminates in a liver biopsy if the imaging and laboratory testing is unrevealing.
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Affiliation(s)
- Jacqueline B Henson
- Division of Gastroenterology, Department of Medicine, Duke University, DUMC Box 3913, Durham, NC 27710, USA. https://twitter.com/jackie_henson
| | - Andrew J Muir
- Division of Gastroenterology, Department of Medicine, Duke University, DUMC Box 3913, Durham, NC 27710, USA; Duke Clinical Research Institute, Duke University, DUMC Box 3913, Durham, NC 27710, USA.
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4
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Goel A, Kwong A. CAQ Corner: Disease recurrence after liver transplantation. Liver Transpl 2022:1. [PMID: 37160054 DOI: 10.1002/lt.26492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 04/09/2022] [Accepted: 04/20/2022] [Indexed: 02/07/2023]
Affiliation(s)
- Aparna Goel
- Division of Gastroenterology/Hepatology, Stanford University, Palo Alto, California, USA
| | - Allison Kwong
- Division of Gastroenterology/Hepatology, Stanford University, Palo Alto, California, USA
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5
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Yoeli D, Choudhury RA, Moore HB, Sauaia A, Simpson MA, Pomfret EA, Nydam TL. Are Hepatitis C Positive Female Liver Transplant Recipients Still at Increased Risk for Graft Failure? Reexamining the Disparity in the Modern Era of Direct-acting Antiviral Agents. Transplantation 2022; 106:129-137. [PMID: 33577252 DOI: 10.1097/tp.0000000000003683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND This study aimed to compare the outcomes of hepatitis C virus (HCV) positive (+) female liver transplant recipients to HCV negative (-) female and HCV+ male recipients before and after the direct-acting-antiviral (DAA) era. METHODS The United Network for Organ Sharing liver transplant database was retrospectively reviewed from 2002 to 2017. The DAA era was defined as ≥2014. RESULTS In the pre-DAA era, HCV+ female recipients had greater risk for graft failure compared with HCV+ male (hazard ratio [HR], 1.06; 95% confidence interval [CI], 1.01-1.11; P = 0.03) and HCV- female (HR, 1.51; 95% CI, 1.43-1.60; P < 0.001) recipients. In the post-DAA era, HCV+ female recipients had lower risk for graft failure compared with HCV+ male recipients (HR, 0.82; 95% CI, 0.70-0.97; P = 0.02) and equivalent outcomes to HCV- female recipients. HCV+ female recipients with graft failure had increased likelihood of graft failure due to disease recurrence compared with HCV+ male recipients in the pre-DAA era (odds ratio, 1.23; 95% CI, 1.08-1.39; P = 0.001) but not in the post-DAA era. CONCLUSIONS Although historically HCV+ female recipients were at disproportionately increased risk for graft failure and disease recurrence, this disparity has been eliminated in the DAA era.
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Affiliation(s)
- Dor Yoeli
- Department of Surgery, University of Colorado School of Medicine, Aurora, CO
| | - Rashikh A Choudhury
- Department of Surgery, University of Colorado School of Medicine, Aurora, CO
| | - Hunter B Moore
- Department of Surgery, University of Colorado School of Medicine, Aurora, CO
| | - Angela Sauaia
- Colorado School of Public Health, University of Colorado Denver, Aurora, CO
| | - Mary Ann Simpson
- Department of Transplantation, Lahey Hospital and Medical Center, Burlington, MA
| | - Elizabeth A Pomfret
- Department of Surgery, University of Colorado School of Medicine, Aurora, CO
| | - Trevor L Nydam
- Department of Surgery, University of Colorado School of Medicine, Aurora, CO
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6
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Garbuzenko DV. [The role of antiviral therapy in the management of patients with liver cirrhosis associated with chronic HBV and HCV infection]. Vopr Virusol 2021; 66:331-339. [PMID: 34738448 DOI: 10.36233/0507-4088-70] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 11/04/2021] [Indexed: 12/12/2022]
Abstract
The formation of the liver cirrhosis (LC) is an unfavorable event of the natural history of chronic liver diseases being accompanied by complications that often cause a fatal outcome. The study of the effectiveness of drugs that affect various etiopathogenetic mechanisms of this condition is an urgent problem of modern hepatology.The aim of the review was to show the role of antiviral therapy (AVT) in the management of patients with LC associated with chronic HBV (hepatitis B virus) and HCV (hepatitis C virus) infection.PubMed database, Google Scholar search engine, Cochrane Systematic Reviews, eLIBRARY.RU electronic scientific library, as well as the reference lists of articles were used to search for scientific articles. The relevant objectives of the review of the publications were identified for the period since 2000 up to 2021 by the search queries as following: «liver cirrhosis», «liver fibrosis», «chronic HBV infection», «chronic HCV infection», «portal hypertension», «treatment». The inclusion criteria were restricted to the management of patients with LC associated with chronic HBV and HCV infection.Current guidelines recommend indefinite treatment of patients with HBV-associated LC with nucleos(t)ide analogues regardless of serum HBV DNA levels, while the modern concept of using direct-acting antiviral drug combinations has become the standard treatment for HCV-associated cirrhosis. Studies have shown the ability of AVT to inhibit and reverse fibrotic processes in LC associated with chronic HBV and HCV infection. It has also been reported that HBV/HCV eradication prior to orthotopic liver transplantation improves long-term overall survival.This, in turn, can reduce the severity of portal hypertension and decrease the risk of associated complications, as well as normalize liver function. Thus, ensuring the availability of drugs for those in need of AVT will not only help prevent the development of LC, but also improve the quality of life and increase its expectancy of patients suffering from this disease.
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Affiliation(s)
- D V Garbuzenko
- FSBEI HE «South Ural State Medical University» of the Ministry of the Health of Russia
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7
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Sanghi V, Romero-Marrero C, Flocco G, Graham RP, Abduljawad B, Niyazi F, Asfari MM, Hashimoto K, Eghtesad B, Menon KVN, Aucejo FN, Lopez R, Yerian LM, Allende DS. The spectrum of histopathological findings after SVR to DAA for recurrent HCV infection in liver transplant recipients. Virchows Arch 2021; 480:335-347. [PMID: 34498114 DOI: 10.1007/s00428-021-03191-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 08/07/2021] [Accepted: 08/17/2021] [Indexed: 10/20/2022]
Abstract
Sustained virological response (SVR) to the treatment of recurrent HCV in liver transplant recipients has excellent clinical outcomes; however, little is known about the effects on allograft histology. The study aimed to assess the histology of the allograft liver. In this single-center, retrospective cohort study, patients with recurrent hepatitis C (HCV) in allograft liver who were cured with antiviral therapy between 2010 and 2016 were identified. Biopsies were reviewed by two liver pathologists blinded to the treatment and SVR status. Paired analysis was performed to compare pre- and post-treatment histological features. Of the 62 patients analyzed, 22 patients received PEGylated interferon/ribavirin (IFN) therapy, while 40 patients received direct-acting antiviral agents (DAA). The mean age was 57 years, 24% were female, and 79% were Caucasian. RNA in situ hybridization testing for HCV and HEV was negative in all the tested patients. Significant reduction in the inflammatory grade of post-treatment biopsy specimens was noted in all subjects (n = 57; p < 0.001) and in the IFN group (n = 21; p = 0.001) but not in the DAA group (p = 0.093). Of all subjects, 21% had worsening stage, 31% had improvement, and 48% had no change in stage. Of the treatment groups, 27% in the IFN and 17% in the DAA groups had worsening stage; however, the results were not statistically significant in all subjects or by treatment modality. Persistent inflammatory infiltrates and fibrosis was noted in allograft tissue of patients cured with DAA. Significant improvement in grade was noted in the IFN group, without a significant change in stage.
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Affiliation(s)
- Vedha Sanghi
- Department of Gastroenterology, University of Mississippi Medical Center, Jackson, MS, USA
| | - Carlos Romero-Marrero
- Department of Gastroenterology and Hepatology, Memorial Healthcare System, Hollywood, FL, USA
| | - Gianina Flocco
- Department of Gastroenterology, Hepatology and Nutrition, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Rondell P Graham
- Department of Gastroenterology & Liver Pathology, Mayo Clinic, Rochester, MN, USA
| | - Baraa Abduljawad
- Department of Critical Care Medicine/Transplant Hepatology, Cleveland Clinic Foundation, Abu Dhabi, United Arab Emirates
| | - Fadi Niyazi
- Department of Gastroenterology, Hepatology and Nutrition, University of Iowa, Iowa City, IA, USA
| | - Mohammad M Asfari
- Department of Gastroenterology, Hepatology and Nutrition, Augusta University, Augusta, GA, USA
| | - Koji Hashimoto
- Department of Surgery - Liver Transplantation, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Bijan Eghtesad
- Department of Surgery - Liver Transplantation, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - K V Narayanan Menon
- Department of Gastroenterology, Hepatology and Nutrition, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Federico N Aucejo
- Department of Surgery - Liver Transplantation, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Rocio Lopez
- Department of Quantitative Health Sciences, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Lisa M Yerian
- Department of Gastrointestinal and Hepatobiliary Pathology, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Daniela S Allende
- Department of Gastrointestinal and Hepatobiliary Pathology, Cleveland Clinic Foundation, Cleveland, OH, USA.
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8
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Guedes de Sá KS, Amoras EDSG, Conde SRSDS, Queiroz MAF, Cayres-Vallinoto IMV, Ishak R, Vallinoto ACR. Intrahepatic TLR3 and IFNL3 Expressions Are Associated with Stages of Fibrosis in Chronic Hepatitis C. Viruses 2021; 13:1103. [PMID: 34207750 PMCID: PMC8230343 DOI: 10.3390/v13061103] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 05/21/2021] [Accepted: 06/02/2021] [Indexed: 12/12/2022] Open
Abstract
An inefficient immune response against the hepatitis C virus (HCV), combined with viral evasion mechanisms, is responsible for the chronicity of infection. The need to evaluate the innate mechanisms of the immune response, such as TLR3 and IFN-λ3, and their relationship with the virus-host interaction is important for understanding the pathogenesis of chronic hepatitis C. The present study aimed to investigate the gene expressions of TRL3 and IFNL3 in liver tissue, seeking to evaluate whether these could be potential biomarkers of HCV infection. A total of 23 liver biopsy samples were collected from patients with chronic HCV, and 8 biopsies were collected from healthy control patients. RNA extraction, reverse transcription and qPCR were performed to quantify the relative gene expressions of TLR3 and IFNL3. Data on the viral load; AST, ALT, GGT and AFP levels; and the viral genotype were collected from the patients' medical records. The intrahepatic expression of TLR3 (p = 0.0326) was higher in chronic HCV carriers than in the control group, and the expression of IFNL3 (p = 0.0037) was lower in chronic HCV carriers than in the healthy control group. The expression levels of TLR3 (p = 0.0030) and IFNL3 (p = 0.0036) were higher in the early stages of fibrosis and of necroinflammatory activity in the liver; in contrast, TLR3 and IFNL3 expressions were lower in the more advanced stages of fibrosis and inflammation. There was no correlation between the gene expression and the serum viral load. Regarding the initial METAVIR scale scores, liver transaminase levels were lower in patients with advanced fibrosis when correlated with TLR3 and IFNL3 gene expressions. The results suggest that in the early stages of the development of hepatic fibrosis, TLR3 and IFN-λ3 play important roles in the antiviral response and in the modulation of the tolerogenic liver environment because there is a decrease in the intrahepatic expressions of TLR3 and IFNL3 in the advanced stages of fibrosis, probably due to viral evasion mechanisms.
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Affiliation(s)
- Keyla Santos Guedes de Sá
- Laboratory of Virology, Institute of Biological Sciences, Federal University of Pará, Belém 66.075-110, PA, Brazil; (K.S.G.d.S.); (E.d.S.G.A.); (M.A.F.Q.); (I.M.V.C.-V.); (R.I.)
- Graduate Program in Biology of Infectious and Parasitic Agents—PPG-BAIP, Institute of Biological Sciences, Federal University of Pará, Belém 66.075-110, PA, Brazil
| | - Ednelza da Silva Graça Amoras
- Laboratory of Virology, Institute of Biological Sciences, Federal University of Pará, Belém 66.075-110, PA, Brazil; (K.S.G.d.S.); (E.d.S.G.A.); (M.A.F.Q.); (I.M.V.C.-V.); (R.I.)
| | - Simone Regina Souza da Silva Conde
- João de Barros Barreto University Hospital, Federal University of Pará, Belém 66073-000, PA, Brazil;
- School of Medicine, Institute of Health Sciences, Federal University of Pará, Umarizal, Belém 66.075-110, PA, Brazil
| | - Maria Alice Freitas Queiroz
- Laboratory of Virology, Institute of Biological Sciences, Federal University of Pará, Belém 66.075-110, PA, Brazil; (K.S.G.d.S.); (E.d.S.G.A.); (M.A.F.Q.); (I.M.V.C.-V.); (R.I.)
| | - Izaura Maria Vieira Cayres-Vallinoto
- Laboratory of Virology, Institute of Biological Sciences, Federal University of Pará, Belém 66.075-110, PA, Brazil; (K.S.G.d.S.); (E.d.S.G.A.); (M.A.F.Q.); (I.M.V.C.-V.); (R.I.)
| | - Ricardo Ishak
- Laboratory of Virology, Institute of Biological Sciences, Federal University of Pará, Belém 66.075-110, PA, Brazil; (K.S.G.d.S.); (E.d.S.G.A.); (M.A.F.Q.); (I.M.V.C.-V.); (R.I.)
| | - Antonio Carlos Rosário Vallinoto
- Laboratory of Virology, Institute of Biological Sciences, Federal University of Pará, Belém 66.075-110, PA, Brazil; (K.S.G.d.S.); (E.d.S.G.A.); (M.A.F.Q.); (I.M.V.C.-V.); (R.I.)
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9
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Abstract
Hepatitis C virus (HCV) is a small positive-sense, single-stranded RNA virus, the causal organism for chronic hepatitis. Chronic hepatitis leads to inflammation of liver, causing cirrhosis, fibrosis and steatosis, which may ultimately lead to liver cancer in a few cases. Innate and adaptive immune responses play an important role in the pathogenesis of HCV infection, thus acting as an important component in deciding the fate of the disease. Numerous studies have indicated that the derangement of these immune responses results in the persistence of infection leading to chronic state of the disease. Interactions between virus and host immune system generally result in the elimination of virus, but as the virus evolves with different evading mechanisms, it makes environment favourable for its survival and replication. It has been reported that HCV impairs the immune system by functional modulation of the cells of innate as well as adaptive immune responses, resulting in chronic state of the disease, influencing the response to antiviral therapy in these patients. These defects in the immune system lead to suboptimal immune responses and therefore, impaired effector functions. This review highlights the involvement or association of different immune cells such as natural killer cells, B cells, dendritic cells and T cells in HCV infection and how the virus plays a role in manipulating certain regulatory mechanisms to make these cells dysfunctional for its own persistence and survival.
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Affiliation(s)
- Shallu Tomer
- Department of Immunopathology, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | - Sunil K Arora
- Department of Immunopathology, Postgraduate Institute of Medical Education & Research, Chandigarh, India
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10
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Paradigm Shift in Utilization of Livers from Hepatitis C-Viremic Donors into Hepatitis C Virus-Negative Patients. Clin Liver Dis 2021; 25:195-207. [PMID: 33978579 DOI: 10.1016/j.cld.2020.08.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Despite record-breaking numbers of liver transplants (LTs) performed in the United States in each of the last 7 years, many patients remain on the wait list as the demand for LT continues to exceed the supply of available donors. The emergence of highly effective and well-tolerated direct-acting antiviral therapy has transformed the clinical course and management of hepatitis C virus (HCV) in both the pretransplant and posttransplant setting. Historically, donor livers infected with HCV were either transplanted into patients already infected with HCV or discarded.
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11
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Ndako JA, Owolabi AO, Olisa JA, Akinwumi JA, Dojumo VT, Olatinsu O, Adebayo BA. Studies on the prevalence of Hepatitis C virus infection in diabetic patients attending a tertiary health-care facility South-west Nigeria. BMC Infect Dis 2020; 20:664. [PMID: 32907538 PMCID: PMC7488326 DOI: 10.1186/s12879-020-05388-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Accepted: 08/31/2020] [Indexed: 02/08/2023] Open
Abstract
Background Hepatitis C virus (HCV) infection and type 2 diabetes mellitus (T2DM) are two major public health problems associated with increasing complications and mortality rates worldwide. The objective of this study is to evaluate the prevalence of hepatitis C virus (HCV) infection in diabetic patients and to investigate the influence of several epidemiological and clinical factors on HCV infection. Method A total number of one hundred and eighty diabetic patients were recruited for this study. Consented subjects made up of 71(39.4%) males and 109(60.56%) females were recruited for the study. While one-Hundred (100) Non-Diabetics (Controls) were also recruited for the study. Structured questionnaires were administered to the consented participants to obtain relevant data. Sera samples were assayed for antibodies to HCV using an enzyme linked immunosorbent assay [Inteco Diagnostic Limited]. ELISA technique. Result Overall prevalence of HCV infection among diabetes patients assayed was 13.3% out of which 8(11.3%) was obtained from the male subjects compared to 16 (14.7%) seropositivity recorded among the females (P = 0.511; P > 0.05). Considering age distribution, Subjects aged 41–50 years recorded, 9 (22.5%) positivity (P = 0.238; P > 0.05).Considering educational status of subjects screened, 22 (14.9%) positivity was rescored among subjects who have attained tertiary status of education.(P = 0.574;P > 0.05).Risk factors considered showed that, 7 (18.9%) seropositive subject were alcoholic consumers(P value = 0.2621;P > 0.05) while 5 (8.9%) recorded history of sharing sharp objects P = 0.2427;P > 0.05). Conclusion Our study shows a slightly higher prevalence of hepatitis C infection in type 2 diabetics. This call for urgent routine screening exercise among diabetic patients for HCV infection. This study also emphasizes the need for public enlightenment on the association between HCV infection and T2DM, to avert possible complications among diabetic patients.
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Affiliation(s)
- James A Ndako
- Department of Microbiology, Landmark University, Omu-aran, Nigeria.
| | | | - Joseph A Olisa
- Department of Medical Services, Landmark University Medical Center, LMU, Omu-aran, Nigeria
| | - Jeremiah A Akinwumi
- Department of Medical Laboratory Services, Landmark University Medical Center, LMU, Omu-aran, Nigeria
| | - Victor T Dojumo
- Department of Medical Laboratory Services, Landmark University Medical Center, LMU, Omu-aran, Nigeria
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12
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Yamamichi S, Miuma S, Wada T, Masumoto H, Kanda Y, Shibata H, Miyaaki H, Taura N, Ichikawa T, Yamamoto T, Nakao K. Deep sequence analysis of NS5A resistance-associated substitution changes in patients reinfected with the hepatitis C virus after liver transplantation. J Viral Hepat 2020; 27:552-555. [PMID: 31895483 DOI: 10.1111/jvh.13256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Revised: 12/01/2019] [Accepted: 12/24/2019] [Indexed: 12/09/2022]
Affiliation(s)
- Shinobu Yamamichi
- Department of Gastroenterology and Hepatology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Satoshi Miuma
- Department of Gastroenterology and Hepatology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Takayuki Wada
- Department of International Health, Institute of Tropical Medicine, Nagasaki University, Nagasaki, Japan.,School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
| | - Hiroshi Masumoto
- Biomedical Research Support Center, Nagasaki University School of Medicine, Nagasaki, Japan
| | - Yasuko Kanda
- Department of Gastroenterology and Hepatology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Hidetaka Shibata
- Department of Gastroenterology and Hepatology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Hisamitsu Miyaaki
- Department of Gastroenterology and Hepatology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Naota Taura
- Department of Gastroenterology and Hepatology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Tatsuki Ichikawa
- Department of Gastroenterology, Nagasaki Harbor Medical Center City Hospital, Nagasaki, Japan
| | - Taro Yamamoto
- Department of International Health, Institute of Tropical Medicine, Nagasaki University, Nagasaki, Japan
| | - Kazuhiko Nakao
- Department of Gastroenterology and Hepatology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
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13
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Erard-Poinsot D, Dharancy S, Hilleret MN, Faure S, Lamblin G, Chambon-Augoyard C, Donnadieu-Rigole H, Lassailly G, Boillot O, Ursic-Bedoya J, Guillaud O, Leroy V, Pageaux GP, Dumortier J. Natural History of Recurrent Alcohol-Related Cirrhosis After Liver Transplantation: Fast and Furious. Liver Transpl 2020; 26:25-33. [PMID: 31562696 DOI: 10.1002/lt.25647] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2019] [Accepted: 08/10/2019] [Indexed: 12/13/2022]
Abstract
Alcohol-related liver disease (ALD) is one of the main indications for liver transplantation (LT). Severe alcohol relapse can rapidly lead to recurrent alcohol-related cirrhosis (RAC) for the graft. The aim of this study was to describe the natural history of RAC and the overall survival after LT and after an RAC diagnosis. From 1992 to 2012, 812 patients underwent primary LT for ALD in 5 French transplant centers. All patients with severe alcohol relapse and an RAC diagnosis on the graft were included. The diagnosis of cirrhosis was based on the analysis of liver biopsy or on the association of clinical, biological, radiological, and/or endoscopic features of cirrhosis. RAC was diagnosed in 57/162 patients (35.2%) with severe alcohol relapse, and 31 (54.4%) of those patients had at least 1 episode of liver decompensation. The main types of decompensation were ascites (70.9%), jaundice (58.0%), and hepatic encephalopathy (9.6%). The cumulative probability of decompensation was 23.8% at 5 years, 50.1% at 10 years, and 69.9% at 15 years after LT. During the follow-up, 36 (63.2%) patients died, the main cause of death being liver failure (61.1%). After diagnosis of cirrhosis, the survival rate was 66.3% at 1 year, 37.8% at 5 years, and 20.6% at 10 years. In conclusion, RAC is associated with a high risk of liver decompensation and a poor prognosis. Prevention of severe alcohol relapse after LT is a major goal to improve patient survival.
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Affiliation(s)
- Domitille Erard-Poinsot
- Fédération des Spécialités Digestives, Hôpital Édouard Herriot, Hospices Civils de Lyon, Université Claude Bernard Lyon 1, Lyon, France
| | - Sébastien Dharancy
- Service de Chirurgie Digestive et Transplantation, Pôle Médico-Chirurgical Huriez, Hôpital Claude Huriez, Université Lille 2, Lille, France
| | - Marie-Noëlle Hilleret
- Clinique Universitaire d'Hépato-Gastroentérologie, Pole Digidune, Centre Hospitalier Universitaire de Grenoble, Université Grenoble Alpes, INSERM U823, Grenoble, France
| | - Stéphanie Faure
- Unité de Transplantation Hépatique, Pôle Digestif, Centre Hospitalier Universitaire de Saint-Eloi, Université Montpellier, Montpellier, France
| | - Géraldine Lamblin
- Service d'Hépatologie et Gastroentérologie, Centre Hospitalier Universitaire de Clermont-Ferrand, Clermont-Ferrand, France
| | - Christine Chambon-Augoyard
- Fédération des Spécialités Digestives, Hôpital Édouard Herriot, Hospices Civils de Lyon, Université Claude Bernard Lyon 1, Lyon, France
| | - Hélène Donnadieu-Rigole
- Unité de Transplantation Hépatique, Pôle Digestif, Centre Hospitalier Universitaire de Saint-Eloi, Université Montpellier, Montpellier, France
| | - Guillaume Lassailly
- Service de Chirurgie Digestive et Transplantation, Pôle Médico-Chirurgical Huriez, Hôpital Claude Huriez, Université Lille 2, Lille, France
| | - Olivier Boillot
- Fédération des Spécialités Digestives, Hôpital Édouard Herriot, Hospices Civils de Lyon, Université Claude Bernard Lyon 1, Lyon, France
| | - José Ursic-Bedoya
- Unité de Transplantation Hépatique, Pôle Digestif, Centre Hospitalier Universitaire de Saint-Eloi, Université Montpellier, Montpellier, France
| | - Olivier Guillaud
- Fédération des Spécialités Digestives, Hôpital Édouard Herriot, Hospices Civils de Lyon, Université Claude Bernard Lyon 1, Lyon, France
| | - Vincent Leroy
- Clinique Universitaire d'Hépato-Gastroentérologie, Pole Digidune, Centre Hospitalier Universitaire de Grenoble, Université Grenoble Alpes, INSERM U823, Grenoble, France
| | - Georges-Philippe Pageaux
- Unité de Transplantation Hépatique, Pôle Digestif, Centre Hospitalier Universitaire de Saint-Eloi, Université Montpellier, Montpellier, France
| | - Jérôme Dumortier
- Fédération des Spécialités Digestives, Hôpital Édouard Herriot, Hospices Civils de Lyon, Université Claude Bernard Lyon 1, Lyon, France
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14
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El-Meteini M, Sakr M, Eldorry A, Mohran Z, Abdelkader NA, Dabbous H, Montasser I, Refaie R, Salah M, Aly M. Non-Invasive Assessment of Graft Fibrosis After Living Donor Liver Transplantation: Is There Still a Role for Liver Biopsy? Transplant Proc 2019; 51:2451-2456. [PMID: 31358454 DOI: 10.1016/j.transproceed.2019.01.197] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Accepted: 01/03/2019] [Indexed: 12/13/2022]
Abstract
Non-invasive methods have evolved as a surrogate for liver biopsy such as indirect markers (aspartate transaminase to platelet ratio index, fibro-α score), transient elastography (TE), and magnetic resonance elastography (MRE). The aim of this study is to prospectively compare the value of MRE, TE, and indirect markers in detecting and staging allograft fibrosis compared to liver biopsies in patients who have undergone living donor liver transplantation for complications related to hepatitis C virus. A total of 31 living donor liver transplantation recipients with hepatitis C virus recurrence underwent a liver biopsy, TE, and MRE within 3 months of a liver biopsy. Fibrosis was assessed according to the biopsy and staged according to Metavir criteria. There was a significant correlation between both MRE and fibro-α scores, as well as histologic classification by liver biopsy (P = .02, .002). The diagnostic accuracy of MRE and fibro-α scores in diagnosing significant fibrosis (F ≥ 3) was measured as the area under the curve (.708 and .833, respectively). Both methods showed good diagnostic performance. TE and aspartate transaminase to platelet ratio index were insignificantly correlated with the degree of fibrosis in liver biopsy (P value of .134, .535). At a cutoff value of 5.5 kPa, MRE predicted graft fibrosis (Metavir stage ≥ 3) with 71.43% sensitivity, 75% specificity, 45.5% positive predictive value, and 90% negative predictive value; at a cutoff value > 1.47, fibro-α scores predicted significant graft fibrosis (Metavir stage ≥ 3) with 85.7% sensitivity and 70.83% specificity, with a positive predictive value of 46.2% and a negative predictive value of 94.4%. These data suggest that non-invasive methods could be considered a reliable tool in assessing significant graft fibrosis post-living donor liver transplantation.
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Affiliation(s)
- M El-Meteini
- Department of Hepatobiliary Surgery & Liver Transplantation, Ain Shams Center for Organ Transplantation (ASCOT), Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - M Sakr
- Tropical Medicine Department, Ain Shams Center for Organ Transplantation (ASCOT), Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - A Eldorry
- Interventional Radiology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Z Mohran
- Tropical Medicine Department, Ain Shams Center for Organ Transplantation (ASCOT), Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - N A Abdelkader
- Tropical Medicine Department, Ain Shams Center for Organ Transplantation (ASCOT), Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - H Dabbous
- Tropical Medicine Department, Ain Shams Center for Organ Transplantation (ASCOT), Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - I Montasser
- Tropical Medicine Department, Ain Shams Center for Organ Transplantation (ASCOT), Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - R Refaie
- Internal Medicine Department, Faculty of Medicine, Helwan University, Cairo, Egypt
| | - M Salah
- Tropical Medicine Department, Ain Shams Center for Organ Transplantation (ASCOT), Faculty of Medicine, Ain Shams University, Cairo, Egypt.
| | - M Aly
- Tropical Medicine Department, Ain Shams Center for Organ Transplantation (ASCOT), Faculty of Medicine, Ain Shams University, Cairo, Egypt
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15
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The associations between Toll-like receptor 4 gene polymorphisms and hepatitis C virus infection: a systematic review and meta-analysis. Biosci Rep 2019; 39:BSR20182470. [PMID: 30765614 PMCID: PMC6390129 DOI: 10.1042/bsr20182470] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Revised: 02/11/2019] [Accepted: 02/12/2019] [Indexed: 02/08/2023] Open
Abstract
Background and objective: The hepatitis C virus (HCV) is able to cause a life-threatening disease relating to lethal hepatocellular carcinoma. Previous, Toll-like receptor polymorphisms were proposed as promising biomarker for HCV-related hepatocellular carcinoma and disease progression. This study aimed to summarize the association of TLR4 polymorphisms and HCV infection through meta-analysis. Methods: We applied a systematic review and meta-analysis performed by using PubMed, EMBASE and Web of Science searches. The Modified Newcastle-Ottawa scale was used for quality assessment. The odd-ratio (OR) and 95% confidence interval (CI) were calculated to assess the association. In silico analysis was applied for proposing the function as microRNA (miRNA) of non-coding polymorphism. Finally, the miRNA target was predicted and annotated to suggest the possible relationship between polymorphism and HCV infection. Results: Our meta-analysis incorporated seven studies involving rs4986791, rs4986790 and rs2149356. No association exists between rs4986791 and HCV infection. However, the heterozygous model (AG vs GG) of rs4986790 significantly associates with HCV infection (OR = 0.33, 95% CI = 0.21–0.49, P<0.0001). Moreover, the rs2149356 TG genotype also associates with HCV infection in the over-dominant model (TG vs TT+TG: OR = 0.54, 95% CI = 0.40–0.75). In silico analysis of rs2149356G allele showed that this mutation is siRNA, which targets the set of genes, especially in the autophagy pathway. Conclusion: We demonstrated that rs4986790 and rs2149356 are associated with HCV infection.
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16
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El-Hamamsy M, Montasser IF, Mansy AES, Nabet DE, El-Meteini M. Effect of cyclosporine A versus tacrolimus on the response to antiviral therapy after hepatitis C genotype-4 recurrence post-liver transplantation: A prospective cohort trial. J Clin Pharm Ther 2019; 44:447-453. [PMID: 30714175 DOI: 10.1111/jcpt.12807] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2018] [Revised: 12/07/2018] [Accepted: 01/08/2019] [Indexed: 12/11/2022]
Abstract
WHAT IS KNOWN AND OBJECTIVE The influence of immunosuppression on the response to antiviral therapy (AVT) for recurrent hepatitis C virus (HCV) infection in liver transplant (LT) recipients remains controversial, especially for the rarely investigated genotype 4. This study aims to compare the effects of the two widely used calcineurin inhibitors (CNIs) (cyclosporine A (CsA) and tacrolimus (Tac)) on the therapeutic response to different AVT regimens. METHODS A prospective, dual-centre, cohort study of 126 Egyptian living donor liver transplant (LDLT) recipients with recurrent HCV genotype 4 infection, who were categorized into three groups according to the AVT used. Group I received pegylated interferon (Peg-IFN-α 2a) plus ribavirin (RBV) (n = 44), group II received the direct antiviral agent (DAA) sofosbuvir plus RBV (n = 52) and group III received daclatasvir and sofosbuvir (also DAAs) plus RBV (n = 30). Each group was further subdivided according to the primary immunosuppression (CsA or Tac). The sustained virological response (SVR) and relapse rates were considered the primary therapeutic outcomes of AVT. RESULTS No significant intergroup differences were observed in the achievement of primary and secondary outcomes. SVR rates in the IFN-based regimen were 75% and 66.7% in CsA and Tac users and 81.2% and 83% in DAAs, respectively. Relapse rates in the IFN-based regimen were 10% and 16.7% in CsA and Tac users and 12.5% and 14.9% in DAAs, respectively. WHAT IS NEW AND CONCLUSION Within the limitations of a relatively small study, CsA did not offer an advantage over Tac regarding the response to AVT after HCV genotype 4 recurrence in LDLT recipients.
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Affiliation(s)
- Manal El-Hamamsy
- Clinical Pharmacy, Faculty of Pharmacy, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Iman Fawzy Montasser
- Tropical Medicine, Faculty of Medicine, Ain Shams Centre for Organ Transplantation (ASCOT), Ain Shams University, Cairo, Egypt
| | - Azza El-Sayed Mansy
- Clinical Pharmacy, Faculty of Pharmacy, El-Fayoum University, El-Fayoum, Egypt
| | - Dina Ezzeldin Nabet
- Pharmaceutical Sciences, Clinical pharmacy, Faculty of Pharmacy, Ain Shams Centre for Organ Transplantation (ASCOT), Ain Shams University Specialized Hospital, Ain Shams University, Cairo, Egypt
| | - Mahmoud El-Meteini
- Hepato-Pancreato-Biliary Surgery, Faculty of Medicine, Ain Shams Centre for Organ Transplantation (ASCOT), Ain Shams University, Cairo, Egypt
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17
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Tasdogan BE, Akosman S, Gurakar M, Simsek C, Gurakar A. Update on Liver Transplantation: What is New Recently? Euroasian J Hepatogastroenterol 2019; 9:34-39. [PMID: 31988865 PMCID: PMC6969330 DOI: 10.5005/jp-journals-10018-1293] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Liver transplantation (LT) is an evolving area of medicine for the treatment of certain types of malignancies and acute and chronic liver failures. Since the topic is evolving, new literature is increasingly available. In recent years, with the emerging potent antiviral therapies, hepatitis C virus-infected patients have successful patient and graft survival outcomes. Even human immunodeficiency virus (HIV) positive patients previously contraindicated for organ transplantation are transplanted with comparable outcomes. With increasing demand for LT, the shortage of the donor pool became the rate limiting factor in this hopeful treatment. To overcome waitlist mortality and expand the donor pool, scoring systems have been modified and organs from HIV and/or hepatitis C infected donors are now accepted, under certain circumstances. The new literature also questions the 6-month alcohol abstinence rule for the transplantation of alcoholic liver disease (ALD), in light of early transplantation results from severe alcoholic hepatitis (SAH) trials. How to cite this article: Tasdogan BE, Akosman S, et al. Update on Liver Transplantation: What is New Recently? Euroasian J Hepatogastroenterol 2019;9(1):34-39.
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Affiliation(s)
- Burcak E Tasdogan
- The Johns Hopkins University School of Medicine, Division of Gastroenterology and Hepatology, Baltimore, Maryland, United States
| | - Sinan Akosman
- The Johns Hopkins University, Baltimore, Maryland, United States
| | - Merve Gurakar
- The Johns Hopkins University, Bloomberg School of Public Health, Baltimore, Maryland, United States
| | - Cem Simsek
- The Johns Hopkins University School of Medicine, Division of Gastroenterology and Hepatology, Baltimore, Maryland, United States
| | - Ahmet Gurakar
- The Johns Hopkins University School of Medicine, Division of Gastroenterology and Hepatology, Baltimore, Maryland, United States
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18
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Lei M, Yan LN, Yang JY, Wen TF, Li B, Wang WT, Wu H, Xu MQ, Chen ZY, Wei YG. Safety of hepatitis B virus core antibody-positive grafts in liver transplantation: A single-center experience in China. World J Gastroenterol 2018; 24:5525-5536. [PMID: 30622380 PMCID: PMC6319134 DOI: 10.3748/wjg.v24.i48.5525] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Revised: 12/08/2018] [Accepted: 12/13/2018] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Given the shortage of suitable liver grafts for liver transplantation, proper use of hepatitis B core antibody-positive livers might be a possible way to enlarge the donor pool and to save patients with end-stage liver diseases. However, the safety of hepatitis B virus core antibody positive (HBcAb+) donors has been controversial. Initial studies were mainly conducted overseas with relatively small numbers of HBcAb+ liver recipients, and there are few relevant reports in the population of mainland China. We hypothesized that the safety of HBcAb+ liver grafts is not suboptimal.
AIM To evaluate the safety of using hepatitis B virus (HBV) core antibody-positive donors for liver transplantation in Chinese patients.
METHODS We conducted a retrospective study enrolling 1071 patients who underwent liver transplantation consecutively from 2005 to 2016 at West China Hospital Liver Transplantation Center. Given the imbalance in several baseline variables, propensity score matching was used, and the outcomes of all recipients were reviewed in this study.
RESULTS In the whole population, 230 patients received HBcAb+ and 841 patients received HBcAb negative (HBcAb-) liver grafts. The 1-, 3- and 5-year survival rates in patients and grafts between the two groups were similar (patient survival: 85.8% vs 87.2%, 77.4% vs 81.1%, 72.4% vs 76.7%, log-rank test, P = 0.16; graft survival: 83.2% vs 83.6%, 73.8% vs 75.9%, 70.8% vs 74.4%, log-rank test, P = 0.19). After propensity score matching, 210 pairs of patients were generated. The corresponding 1-, 3- and 5-year patient and graft survival rates showed no significant differences. Further studies illustrated that the post-transplant major complication rates and liver function recovery after surgery were also similar. In addition, multivariate regression analysis in the original cohort and propensity score-matched Cox analysis demonstrated that receiving HBcAb+ liver grafts was not a significant risk factor for long-term survival. These findings were consistent in both HBV surface antigen-positive (HBsAg+) and HBsAg negative (HBsAg-) patients.
Newly diagnosed HBV infection had a relatively higher incidence in HBsAg- patients with HBcAb+ liver grafts (13.23%), in which HBV naive recipients suffered most (31.82%), although this difference did not affect patient and graft survival (P = 0.50 and P = 0.49, respectively). Recipients with a high HBV surface antibody (anti-HBs) titer (more than 100 IU/L) before transplantation and antiviral prophylaxis with nucleos(t)ide antiviral agents post-operation, such as nucleos(t)ide antiviral agents, had lower de novo HBV infection risks.
CONCLUSION HBcAb+ liver grafts do not affect the long-term outcome of the recipients. Combined with proper postoperative antiviral prophylaxis, utilization of HBcAb+ grafts is rational and feasible.
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Affiliation(s)
- Ming Lei
- Department of Liver Surgery, Liver Transplantation Center, West China Hospital of Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Lu-Nan Yan
- Department of Liver Surgery, Liver Transplantation Center, West China Hospital of Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Jia-Yin Yang
- Department of Liver Surgery, Liver Transplantation Center, West China Hospital of Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Tian-Fu Wen
- Department of Liver Surgery, Liver Transplantation Center, West China Hospital of Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Bo Li
- Department of Liver Surgery, Liver Transplantation Center, West China Hospital of Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Wen-Tao Wang
- Department of Liver Surgery, Liver Transplantation Center, West China Hospital of Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Hong Wu
- Department of Liver Surgery, Liver Transplantation Center, West China Hospital of Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Ming-Qing Xu
- Department of Liver Surgery, Liver Transplantation Center, West China Hospital of Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Zhe-Yu Chen
- Department of Liver Surgery, Liver Transplantation Center, West China Hospital of Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Yong-Gang Wei
- Department of Liver Surgery, Liver Transplantation Center, West China Hospital of Sichuan University, Chengdu 610041, Sichuan Province, China
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19
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Gambato M, Gregori J, Quer J, Koutsoudakis G, González P, Caro-Pérez N, García-Cehic D, García-González N, González-Candelas F, Esteban JI, Crespo G, Navasa M, Forns X, Pérez-Del-Pulgar S. Hepatitis C virus intrinsic molecular determinants may contribute to the development of cholestatic hepatitis after liver transplantation. J Gen Virol 2018; 100:63-68. [PMID: 30451649 DOI: 10.1099/jgv.0.001175] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Cholestatic hepatitis C (CHC) is a severe form of hepatitis C virus (HCV) infection recurrence that leads to high graft loss rates early after liver transplantation (LT). To investigate the pathogenic mechanisms of CHC, we analysed HCV quasispecies in CHC patients compared to a control group (mild hepatitis C recurrence) by deep pyrosequencing. At the time of LT, NS5B quasispecies complexity was similar between the two groups but, after LT, it decreased more sharply in CHC patients than in the control group. Interestingly, the major variant before LT propagated efficiently and remained as the dominant sequence after LT in 62 % of CHC patients versus 11 % of controls (P=0.031). Sequence analysis of the complete non-structural region in a limited number of patients revealed a potential 12 aa signature specific to the CHC group. These data suggest that intrinsic molecular determinants in the circulating HCV quasispecies may provide a fitness advantage, contributing to the development of CHC.
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Affiliation(s)
- Martina Gambato
- 1Liver Unit, Hospital Clínic, IDIBAPS, CIBERehd, University of Barcelona, Barcelona, Spain.,2Multivisceral Transplant Unit and Gastroenterology, Padova University Hospital, Padova, Italy.,†Present address: Multivisceral Transplant Unit and Gastroenterology, Padova University Hospital, Padova, Italy
| | - Josep Gregori
- 3Liver Unit, Vall d'Hebron Institut de Recerca-Hospital Universitari Vall d'Hebron, CIBERehd, Barcelona, Spain.,4Roche Diagnostics SL. Sant Cugat del Vallès, Barcelona, Spain
| | - Josep Quer
- 3Liver Unit, Vall d'Hebron Institut de Recerca-Hospital Universitari Vall d'Hebron, CIBERehd, Barcelona, Spain
| | - George Koutsoudakis
- 1Liver Unit, Hospital Clínic, IDIBAPS, CIBERehd, University of Barcelona, Barcelona, Spain
| | - Patricia González
- 1Liver Unit, Hospital Clínic, IDIBAPS, CIBERehd, University of Barcelona, Barcelona, Spain
| | - Noelia Caro-Pérez
- 1Liver Unit, Hospital Clínic, IDIBAPS, CIBERehd, University of Barcelona, Barcelona, Spain.,‡Present address: Department of Laboratory Medicine, Division of Clinical Microbiology, Karolinska Institutet, Stockholm, Sweden
| | - Damir García-Cehic
- 3Liver Unit, Vall d'Hebron Institut de Recerca-Hospital Universitari Vall d'Hebron, CIBERehd, Barcelona, Spain
| | - Neris García-González
- 5Joint Research Unit Infección y Salud Pública, FISABIO-Universitat de València, I2SysBio, CIBERESP, Valencia, Spain
| | - Fernando González-Candelas
- 5Joint Research Unit Infección y Salud Pública, FISABIO-Universitat de València, I2SysBio, CIBERESP, Valencia, Spain
| | - Juan Ignacio Esteban
- 3Liver Unit, Vall d'Hebron Institut de Recerca-Hospital Universitari Vall d'Hebron, CIBERehd, Barcelona, Spain
| | - Gonzalo Crespo
- 1Liver Unit, Hospital Clínic, IDIBAPS, CIBERehd, University of Barcelona, Barcelona, Spain
| | - Miquel Navasa
- 1Liver Unit, Hospital Clínic, IDIBAPS, CIBERehd, University of Barcelona, Barcelona, Spain
| | - Xavier Forns
- 1Liver Unit, Hospital Clínic, IDIBAPS, CIBERehd, University of Barcelona, Barcelona, Spain
| | - Sofía Pérez-Del-Pulgar
- 1Liver Unit, Hospital Clínic, IDIBAPS, CIBERehd, University of Barcelona, Barcelona, Spain
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20
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Houssel-Debry P, Coilly A, Fougerou-Leurent C, Jezequel C, Duvoux C, De Ledinghen V, Radenne S, Kamar N, Leroy V, Martino VD, D'Alteroche L, Canva V, Conti F, Dumortier J, Montialoux H, Lebray P, Botta-Fridlund D, Tran A, Moreno C, Silvain C, Besch C, Perre P, Francoz C, Abergel A, Habersetzer F, Debette-Gratien M, Cagnot C, Diallo A, Chevaliez S, Rossignol E, Veislinger A, Duclos-Vallee JC, Pageaux GP. 12 Weeks of a Ribavirin-Free Sofosbuvir and Nonstructural Protein 5A Inhibitor Regimen Is Enough to Treat Recurrence of Hepatitis C After Liver Transplantation. Hepatology 2018; 68:1277-1287. [PMID: 29633389 DOI: 10.1002/hep.29918] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Accepted: 04/02/2018] [Indexed: 12/12/2022]
Abstract
UNLABELLED Sofosbuvir (SOF) combined with nonstructural protein 5A (NS5A) inhibitors has demonstrated its efficacy in treating a recurrence of hepatitis C virus (HCV) after liver transplantation (LT). However, the duration of treatment and need for ribavirin (RBV) remain unclear in this population. Our aim was to determine whether LT recipients could be treated with an SOF + NS5A inhibitor-based regimen without RBV for 12 weeks post-LT. Between October 2013 and December 2015, 699 LT recipients experiencing an HCV recurrence were enrolled in the multicenter ANRS CO23 CUPILT cohort. We selected patients receiving SOF and NS5A inhibitor ± RBV and followed for at least 12 weeks after treatment discontinuation. The primary efficacy endpoint was a sustained virological response 12 weeks after the end of treatment (SVR12). Among these 699 patients, 512 fulfilled the inclusion criteria. Their main characteristics were: 70.1% genotype 1, 18.2% genotype 3, 21.1% cirrhosis, and 34.4% previously treated patients. We identified four groups of patients according to their treatment and duration: SOF + NS5A without RBV for 12 (156 patients) or 24 (239 patients) weeks; SOF + NS5A + RBV for 12 (47 patients) or 24 (70 patients) weeks. SVR12 values reached 94.9%, 97.9%, 95.7%, and 92.9%, respectively (P = 0.14). Only 20 patients experienced a treatment failure. Under multivariate analysis, factors such as fibrosis stage, previous treatment, HCV genotype, and baseline HCV viral load did not influence SVR12 rates in the four groups (P = 0.21). Hematological adverse events (AEs) were more common in the RBV group: anemia (P < 0.0001) and blood transfusion (P = 0.0001). CONCLUSION SOF + NS5A inhibitors without RBV for 12 weeks constituted reliable therapy for recurrent HCV post-LT with an excellent SVR12 whatever the fibrosis stage, HCV genotype, and previous HCV treatment. (Hepatology 2018; 00:000-000).
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Affiliation(s)
- Pauline Houssel-Debry
- Hepatology and Liver Transplant Unit, Pontchaillou University Hospital, Rennes, France
| | - Audrey Coilly
- Hepatobiliary Center, AP-HP Paul Brousse Hospital, Villejuif, France.,Paris Sud University, Paris Sud Saclay University, UMR-S 1193, Villejuif, France.,INSERM, Unité 1193, Villejuif, France.,DHU Hepatinov, Villejuif, France
| | - Claire Fougerou-Leurent
- Pharmacology Unit, CHU Rennes, Rennes, France.,INSERM, CIC 1414 Clinical Investigation Centre, Rennes, France
| | - Caroline Jezequel
- Hepatology and Liver Transplant Unit, Pontchaillou University Hospital, Rennes, France
| | | | | | - Sylvie Radenne
- Hepatology Unit, HCL, Hôpital de la Croix-Rousse, Lyon, France
| | - Nassim Kamar
- Nephrology and Organ Transplantation Unit, CHU Rangueil, INSERM U1043, IFR-BMT, Paul Sabatier University, Toulouse, France
| | - Vincent Leroy
- Hepato-Gastroenterolgy Unit, Pôle Digidune, CHU Grenoble, Grenoble, France
| | - Vincent Di Martino
- Hepatology Unit, CHRU Jean Minjoz Franche Comté University, Besançon, France
| | | | - Valérie Canva
- CHRU Lille, Hepatology Unit, Claude Huriez Hospital, CHRU Lille, Lille, France
| | - Filomena Conti
- Hepatology and Liver Transplant Unit, AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
| | - Jerome Dumortier
- Liver Transplant Unit, Digestive Diseases Federation, Edouard Herriot Hospital, Hospices Civils de Lyon Université Claude Bernard Lyon 1, Lyon, France
| | | | - Pascal Lebray
- Hepatology and Liver Transplant Unit, AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
| | | | - Albert Tran
- Hepatogastroenterology Unit, Nice University Hospital, INSERM, U1065, Equipe 8, Nice Sophia Antipolis University, Faculty of Medicine, Nice, Cedex 2, Nice, France
| | - Christophe Moreno
- Hepatogastroenterology Unit, CUB Hôpital Erasme, Brussels University, Bruxelles, Belgique
| | | | - Camille Besch
- Liver Transplant and Digestive Surgery Unit, Strasbourg University, Strasbourg, France
| | - Philippe Perre
- Infectious Diseases Unit, CHD Vendée, La Roche sur Yon, Strasbourg, France
| | - Claire Francoz
- Hepatology Unit, Beaujon Hospita, Assistance Publique-Hôpitaux de Paris, Clichy, France
| | - Armando Abergel
- Hepatogastroenterology Unit, CHU Estaing Clermont-Ferrand, Clermont-Ferrand, France
| | - François Habersetzer
- Universitary Hospitals of Strasbourg, Inserm U 1110, LabEx HepSYS, Strasbourg University, Strasbourg, France
| | | | - Carole Cagnot
- Unité de recherche Clinique et Fondamentale sur les Hépatites Virales, ANRS (France REcherche Nord&sud Sida-hiv Hépatites), Paris, France
| | - Alpha Diallo
- Unité de recherche Clinique et Fondamentale sur les Hépatites Virales, ANRS (France REcherche Nord&sud Sida-hiv Hépatites), Paris, France
| | - Stéphane Chevaliez
- Virology Unit, French National Reference Center for Viral Hepatitis B, C and delta French National Reference Center for Viral Hepatitis B, C and delta, Hôpital Henri Mondor, Université Paris 12, Paris, France
| | - Emilie Rossignol
- Pharmacology Unit, CHU Rennes, Rennes, France.,INSERM, CIC 1414 Clinical Investigation Centre, Rennes, France
| | - Aurélie Veislinger
- Pharmacology Unit, CHU Rennes, Rennes, France.,INSERM, CIC 1414 Clinical Investigation Centre, Rennes, France
| | - Jean-Charles Duclos-Vallee
- Hepatobiliary Center, AP-HP Paul Brousse Hospital, Villejuif, France.,Paris Sud University, Paris Sud Saclay University, UMR-S 1193, Villejuif, France.,INSERM, Unité 1193, Villejuif, France.,DHU Hepatinov, Villejuif, France
| | - Georges-Philippe Pageaux
- Liver transplant and Hepatogastroenterology Unit, CHU Saint-Eloi, Montpellier University, Montpellier, France
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21
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de Ruiter PE, Gadjradj Y, de Knegt RJ, Metselaar HJ, Ijzermans JNM, van der Laan LJW. Interaction of immunosuppressants with HCV antivirals daclatasvir and asunaprevir: combined effects with mycophenolic acid. World J Transplant 2018; 8:156-166. [PMID: 30211024 PMCID: PMC6134272 DOI: 10.5500/wjt.v8.i5.156] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Revised: 06/14/2018] [Accepted: 06/27/2018] [Indexed: 02/05/2023] Open
Abstract
AIM To investigate the specific effects of immunosuppressants on the antiviral action of daclatasvir and asunaprevir.
METHODS The antiviral activity of daclatasvir (DCV) and asunaprevir (ASV) combined with immunosuppressants was tested using two in vitro models for hepatitis C virus (HCV) infection.
RESULTS Tacrolimus, rapamycin and cyclosporine did not negatively affect the antiviral action of DCV or ASV. Mycophenolic acid (MPA) showed additive antiviral effects combined with these direct acting antivirals (DAAs). MPA induces interferon-stimulated genes (ISGs) and is a potent GTP synthesis inhibitor. DCV or ASV did not induce ISGs expression nor affected ISG induction by MPA. Rather, the combined antiviral effect of MPA with DCV and ASV was partly mediated via inhibition of GTP synthesis.
CONCLUSION Immunosuppressants do not negatively affect the antiviral activity of DAAs. MPA has additive effect on the antiviral action of DCV and ASV. This combined benefit needs to be confirmed in prospective clinical trials.
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Affiliation(s)
- Petra E de Ruiter
- Department of Surgery, Erasmus MC-University Medical Center, Rotterdam CN 3015, the Netherlands
| | - Yashna Gadjradj
- Department of Surgery, Erasmus MC-University Medical Center, Rotterdam CN 3015, the Netherlands
| | - Robert J de Knegt
- Department of Gastroenterology and Hepatology, Erasmus MC-University Medical Center, Rotterdam CN 3015, the Netherlands
| | - Herold J Metselaar
- Department of Gastroenterology and Hepatology, Erasmus MC-University Medical Center, Rotterdam CN 3015, the Netherlands
| | - Jan NM Ijzermans
- Department of Surgery, Erasmus MC-University Medical Center, Rotterdam CN 3015, the Netherlands
| | - Luc JW van der Laan
- Department of Surgery, Erasmus MC-University Medical Center, Rotterdam CN 3015, the Netherlands
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22
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Campos-Varela I, Agudelo EZ, Terrault NA. Outcomes of antiviral treatment in hepatitis C virus liver transplant patients off immunosuppression in the direct acting antivirals era: A case series. Clin Transplant 2018; 32:e13303. [PMID: 29851150 DOI: 10.1111/ctr.13303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/28/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND Clearance of hepatitis C virus (HCV) under antiviral therapy, including direct-acting antivirals (DAAs), has been associated with higher risk of rejection. Whether patients who are not on immunosuppression (IS) during DAA therapy are at higher risk of rejection is unknown. METHODS Four transplant recipients who were off IS and treated with DAA therapy were identified. RESULTS All patients were genotype 1 infection and treated for 12 weeks with sofosbuvir/ledipasvir/ribavirin. At the time of DAA therapy, patients were off IS for a median of 9.5 years. Time from liver transplant (LT) to treatment was 12.9 years. Median baseline ALT was 70 IU/L, at follow-up week 12 was 18 IU/L. No signs of rejection were observed during DAA therapy or follow-up after the end of therapy. All 4 patients obtained sustained virological response. CONCLUSION Direct-acting antivirals therapy in HCV patients off IS post-LT can be successfully undertaken without the need to restart IS.
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Affiliation(s)
- Isabel Campos-Varela
- Universidade de Santiago de Compostela (CLINURSID), Santiago de Compostela, Spain.,Department of Internal Medicine, Hospital of Santiago de Compostela, Santiago de Compostela, Spain
| | - Eliana Z Agudelo
- Department of Medicine, University of California, San Francisco, CA, USA.,Department of Surgery, University of California, San Francisco, CA, USA
| | - Norah A Terrault
- Department of Medicine, University of California, San Francisco, CA, USA.,Department of Surgery, University of California, San Francisco, CA, USA
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23
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De Novo Autoimmune Hepatitis Following Liver Transplantation. Transplant Proc 2018; 50:1451-1456. [DOI: 10.1016/j.transproceed.2018.02.066] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2017] [Revised: 02/01/2018] [Accepted: 02/17/2018] [Indexed: 02/07/2023]
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24
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Bodro M, Sanclemente G, Crespo G, Linares L, Marcos MA, Marco F, Miquel R, Forns X, Navasa M, Moreno A. Severe Hepatitis C Recurrence as a Risk Factor for Opportunistic Infections in Liver Transplant Recipients. Transplant Proc 2018; 50:1437-1443. [PMID: 29880367 DOI: 10.1016/j.transproceed.2018.02.081] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Revised: 12/13/2017] [Accepted: 02/17/2018] [Indexed: 02/07/2023]
Abstract
OBJECTIVE The aim of the study was to determine the clinical characteristics, frequency of opportunistic infections (OI), and the outcomes for liver transplant recipients with severe hepatitis C virus (HCV) recurrence. In addition, the objective was to evaluate HCV recurrence as a risk factor for developing an OI. METHODS We conducted a retrospective observational study recording all liver transplant recipients from July 1, 2003, to December 31, 2012. Patients with liver disease due to HCV were selected. Active surveillance of infections was conducted periodically, and patients were classified according to presence of severe HCV recurrence. RESULTS Three hundred seventy patients underwent liver transplantation because of chronic HCV. One hundred forty-seven patients presented severe recurrence (SR) (49%) and 50 (17%) of them had post-liver transplant cholestatic hepatitis C. Patients with SR presented OI, especially cytomegalovirus (CMV) infections and invasive fungal infections, more frequently than patients without SR (33% vs 13%; P < .001). From the diagnosis of SR to the presentation of OI, the median number of days was 169 (6-2083). Acute allograft rejection (OR 1.8 95% confidence interval [CI] 1.1-3.3) donor age ≥60 years (OR 2.9 95% CI 1.3-6.8), and SR (OR 2.8, 95% CI 1.6-5.1) were independently associated with the development of OI in liver transplant recipients. CONCLUSION A high index of suspicion of opportunistic infections must be maintained when faced with severe HCV recurrence in liver transplant recipients. Moreover, active surveillance against CMV infection and other prophylactic strategies against opportunistic infections should be considered.
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Affiliation(s)
- M Bodro
- Infectious Diseases Department, Hospital Clínic-IDIBAPS-CIBERHED, University of Barcelona, Barcelona, Spain.
| | - G Sanclemente
- Infectious Diseases Department, Hospital Clínic-IDIBAPS-CIBERHED, University of Barcelona, Barcelona, Spain
| | - G Crespo
- Liver Transplant Unit, Hospital Clínic-IDIBAPS-CIBERHED, University of Barcelona, Barcelona, Spain
| | - L Linares
- Infectious Diseases Department, Hospital Clínic-IDIBAPS-CIBERHED, University of Barcelona, Barcelona, Spain
| | - M A Marcos
- Microbiology Department, Hospital Clínic-IDIBAPS-CIBERHED, University of Barcelona, Barcelona, Spain
| | - F Marco
- Microbiology Department, Hospital Clínic-IDIBAPS-CIBERHED, University of Barcelona, Barcelona, Spain
| | - R Miquel
- Pathology Unit, Hospital Clínic-IDIBAPS-CIBERHED, University of Barcelona, Barcelona, Spain
| | - X Forns
- Liver Transplant Unit, Hospital Clínic-IDIBAPS-CIBERHED, University of Barcelona, Barcelona, Spain
| | - M Navasa
- Liver Transplant Unit, Hospital Clínic-IDIBAPS-CIBERHED, University of Barcelona, Barcelona, Spain
| | - A Moreno
- Infectious Diseases Department, Hospital Clínic-IDIBAPS-CIBERHED, University of Barcelona, Barcelona, Spain
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25
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Hepatitis C following liver transplantation: current approach and future research opportunities. Curr Opin Infect Dis 2018; 29:346-52. [PMID: 27191202 DOI: 10.1097/qco.0000000000000274] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
PURPOSE OF REVIEW The treatment of hepatitis C virus infection (HCV) in liver transplant recipients was very limited until direct-acting antivirals became widely available. We review the current approach to HCV treatment following liver transplantation and future research opportunities. RECENT FINDINGS Current treatment of HCV infection with all oral new direct-acting antivirals in the postliver transplant setting is easier, shorter, tolerable, and more effective with high-sustained virological response rates. However, some challenges remain, including the optimal timing of therapy, drug-drug interactions, renal insufficiency, and HIV coinfection. SUMMARY Patients with recurrent HCV following liver transplant will significantly benefit from all oral new direct acting antivirals. Ongoing studies will determine the optimal timing and combination in this unique population.
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26
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Dharancy S, Coilly A, Fougerou-Leurent C, Duvoux C, Kamar N, Leroy V, Tran A, Houssel-Debry P, Canva V, Moreno C, Conti F, Dumortier J, Di Martino V, Radenne S, De Ledinghen V, D'Alteroche L, Silvain C, Besch C, Perré P, Botta-Fridlund D, Francoz C, Habersetzer F, Montialoux H, Abergel A, Debette-Gratien M, Rohel A, Rossignol E, Samuel D, Duclos-Vallée JC, Pageaux GP. Direct-acting antiviral agent-based regimen for HCV recurrence after combined liver-kidney transplantation: Results from the ANRS CO23 CUPILT study. Am J Transplant 2017; 17:2869-2878. [PMID: 28898563 DOI: 10.1111/ajt.14490] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Revised: 08/16/2017] [Accepted: 08/20/2017] [Indexed: 01/25/2023]
Abstract
Hepatitis C virus (HCV) infection is associated with reduced patient survival following combined liver-kidney transplantation (LKT). The aim of this study was to assess the efficacy and safety of second-generation direct-acting antivirals (DAAs) in this difficult-to-treat population. The ANRS CO23 "Compassionate use of Protease Inhibitors in Viral C Liver Transplantation" (CUPILT) study is a prospective cohort including transplant recipients with recurrent HCV infection treated with DAAs. The present work focused on recipients with recurrent infection following LKT. The study population included 23 patients. All patients received at least one NS5B inhibitor (sofosbuvir) in their antiviral regimen an average of 90 months after LKT. Ninety-six percent of recipients achieved a sustained virological response (SVR) at week 12 (SVR12). In terms of tolerance, 39% of recipients presented with at least one serious adverse event. None of the patients experienced acute rejection during therapy and there were no deaths during follow-up. The glomerular filtration rate (GFR) decreased significantly from baseline to the end of therapy. However, this study did not show that the decline in GFR persisted over time or that it was directly related to DAAs. The DAA-based regimen is well tolerated with excellent results in terms of efficacy. It will become the gold standard for the treatment of recurrent HCV following LKT.
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Affiliation(s)
- Sébastien Dharancy
- CHRU Lille, Hepatology Unit, Claude Huriez Hospital, CHRU Lille, Lille, France
| | - Audrey Coilly
- Hepatobiliary Center, AP-HP Paul Brousse Hospital, Villejuif, France.,Paris Sud University, Paris Sud Saclay University, UMR-S 1193, Villejuif, France.,INSERM, Unité 1193, Villejuif, France.,DHU Hepatinov, Villejuif, France
| | - Claire Fougerou-Leurent
- INSERM, CIC 1414 Clinical Investigation Center, Rennes, France.,Pharmacology Unit, CHU Rennes, Rennes, France
| | | | - Nassim Kamar
- Nephrology and Organ Transplantation Unit, CHU Rangueil, INSERM U1043, IFR-BMT, Paul Sabatier University, Toulouse, France
| | - Vincent Leroy
- Hepato-Gastroenterolgy Unit, Pôle Digidune, CHU Grenoble, Grenoble, France
| | - Albert Tran
- Hepatogastroenterology Unit, Nice University Hospital, INSERM, U1065, Equipe 8, Nice Sophia Antipolis University, Faculty of Medicine, Nice, Cedex 2, France
| | - Pauline Houssel-Debry
- Hepatology and Liver Transplant Unit, Pontchaillou University Hospital, Rennes, France
| | - Valérie Canva
- CHRU Lille, Hepatology Unit, Claude Huriez Hospital, CHRU Lille, Lille, France
| | - Christophe Moreno
- Hepatogastroenterology Unit, CUB Hôpital Erasme, Brussels University, Bruxelles, Belgique
| | - Filoména Conti
- Hepatology and Liver Transplant Unit, AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
| | - Jérome Dumortier
- Liver Transplant Unit, Digestive Diseases Federation, Edouard Herriot Hospital, Hospices Civils de Lyon Université Claude Bernard Lyon 1, Lyon, France
| | - Vincent Di Martino
- Hepatology Unit, CHRU Jean Minjoz Franche Comté University, Besançon, France
| | - Sylvie Radenne
- Hepatology Unit, HCL, Hôpital de la Croix-Rousse, Lyon, France
| | - Victor De Ledinghen
- Hepatogastroenterology Unit, Haut Leveque Hospital, CHU Bordeaux & INSERM U1053, Bordeaux, France
| | | | | | - Camille Besch
- Liver Transplant and Digestive Surgery Unit, Strasbourg University, Strasbourg, France
| | - Philippe Perré
- Infectious Diseases Unit, CHD Vendée, La Roche sur Yon, France
| | | | - Claire Francoz
- Hepatology Unit, Beaujon Hospital, Assistance Publique-Hôpitaux de Paris, Clichy, France
| | - François Habersetzer
- Universitary Hospitals of Strasbourg, Inserm U 1110, LabEx HepSYS, Strasbourg University, Strasbourg, France
| | | | - Armand Abergel
- Hepatogastroenterology Unit, CHU Estaing Clermont-Ferrand, Clermont-Ferrand, France
| | | | - Alexandra Rohel
- Unité de recherche Clinique et Fondamentale sur les Hépatites Virales, ANRS (France REcherche Nord&sud Sida-hiv Hépatites), Paris, France
| | - Emilie Rossignol
- INSERM, CIC 1414 Clinical Investigation Center, Rennes, France.,Pharmacology Unit, CHU Rennes, Rennes, France
| | - Didier Samuel
- Hepatobiliary Center, AP-HP Paul Brousse Hospital, Villejuif, France.,Paris Sud University, Paris Sud Saclay University, UMR-S 1193, Villejuif, France.,INSERM, Unité 1193, Villejuif, France.,DHU Hepatinov, Villejuif, France
| | - Jean-Charles Duclos-Vallée
- Hepatobiliary Center, AP-HP Paul Brousse Hospital, Villejuif, France.,Paris Sud University, Paris Sud Saclay University, UMR-S 1193, Villejuif, France.,INSERM, Unité 1193, Villejuif, France.,DHU Hepatinov, Villejuif, France
| | - Georges-Philippe Pageaux
- Liver transplant and Hepatogastroenterology Unit, CHU Saint-Eloi, Montpellier University, Montpellier, France
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27
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Sghaier I, Mouelhi L, Ghazoueni E, Brochot E, Almawi WY, Yacoubi-Loueslati B. Role of TLRs and IL-6 in the outcome of chronic hepatitis C treatment in Tunisian population. Cytokine 2017; 99:297-304. [PMID: 28823914 DOI: 10.1016/j.cyto.2017.08.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Revised: 07/25/2017] [Accepted: 08/12/2017] [Indexed: 12/13/2022]
Abstract
OBJECTIVES TLRs are one of the most studied families of pathogen recognition receptors (PRRs) and play a pivotal role during HCV infection. The binding of ligands to TLRs on antigen presenting cells (APCs) leads to secretion of inflammatory cytokines, such as IL6, and induction of the acquired immunity response. Therefore, it has become necessarily to harness the TLRs properties' on therapeutically tools to enhance the HCV treatment response. Herein, we investigated the association between TLR3, TLR4 variants and nine IL-6 polymorphisms, and response to anti-viral treatment during HCV infection. METHODS Study subjects comprised 120 patients infected with HCV-1b and treated with Peg-IFN/RBV. Genotyping of nine IL-6 variants were done by real -time PCR and genotyping of TLRs polymorphisms were done by RFLP-PCR. RESULTS High frequency of TLR3 rs3775290 C/C genotype and TLR4 rs4986790 A/A genotype were noticed among patients with sustained viral response compared to Non-responder patients. The genetic association of TLR3 and TLR4 variants was evidenced by the improvement in the kinetics of viral load decline, with superiority of TLR3 compared to TLR4. Among, nine polymorphisms studied on IL-6 only rs1800796, rs2069845 and rs1880242 were associated with sustained viral response. Our study reports also that the common favourable IL-28B variant is essential for TLR-activated antiviral protection. CONCLUSION TLR3 and TLR4 are involved in the pathogenesis of viral infections. TLR3 may be better suited than TLR4 to activate anti-viral program. Moreover, we propose that the Th2 cytokine, IL-6, constitutes a determinant of the outcome of therapy in HCV patients.
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Affiliation(s)
- Ikram Sghaier
- University of Tunis El Manar, Faculty of Sciences of Tunis, Laboratory of Mycology, Pathologies and Biomarkers: LR16ES05, 2092, Tunisia.
| | - Leila Mouelhi
- Charles Nicolle Hospital, Hepato-Gastro-Enterology Department, Tunis, Tunisia
| | | | - Etienne Brochot
- Department of Virology, Amiens University Medical Centre, Amiens, France; Virology Research Unit, EA 4294, Jules Verne University of Picardie, Amiens, France
| | - Wassim Y Almawi
- University of Tunis El Manar, Faculty of Sciences of Tunis, Laboratory of Mycology, Pathologies and Biomarkers: LR16ES05, 2092, Tunisia
| | - Besma Yacoubi-Loueslati
- University of Tunis El Manar, Faculty of Sciences of Tunis, Laboratory of Mycology, Pathologies and Biomarkers: LR16ES05, 2092, Tunisia
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28
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Vukotic R, Conti F, Fagiuoli S, Morelli MC, Pasulo L, Colpani M, Foschi FG, Berardi S, Pianta P, Mangano M, Donato MF, Malinverno F, Monico S, Tamè M, Mazzella G, Belli LS, Viganò R, Carrai P, Burra P, Russo FP, Lenci I, Toniutto P, Merli M, Loiacono L, Iemmolo R, Degli Antoni AM, Romano A, Picciotto A, Rendina M, Andreone P. Long-term outcomes of direct acting antivirals in post-transplant advanced hepatitis C virus recurrence and fibrosing cholestatic hepatitis. J Viral Hepat 2017; 24:858-864. [PMID: 28370880 DOI: 10.1111/jvh.12712] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Accepted: 02/22/2017] [Indexed: 12/14/2022]
Abstract
Long-term functional outcomes of sofosbuvir-based antiviral treatment were evaluated in a cohort study involving 16 Italian centres within the international compassionate use programme for post-transplant hepatitis C virus (HCV) recurrence. Seventy-three patients with cirrhosis (n=52) or fibrosing cholestatic hepatitis (FCH, n=21) received 24-week sofosbuvir with ribavirin±pegylated interferon or interferon-free sofosbuvir-based regimen with daclatasvir/simeprevir+ribavirin. The patients were observed for a median time of 103 (82-112) weeks. Twelve of 73 (16.4%) died (10 non-FCH, 2 FCH) and two underwent re-LT. Sustained virological response was achieved in 46 of 66 (69.7%): 31 of 47 (66%) non-FCH and 15 of 19 (79%) FCH patients. All relapsers were successfully retreated. Comparing the data of baseline with last follow-up, MELD and Child-Turcotte-Pugh scores improved both in non-FCH (15.3±6.5 vs 10.5±3.8, P<.0001 and 8.4±2.1 vs 5.7±1.3, P<.0001, respectively) and FCH (17.3±5.9 vs 10.1±2.8, P=.001 and 8.2±1.6 vs 5.5±1, P=.001, respectively). Short-treatment mortality was higher in patients with baseline MELD≥25 than in those with MELD<25 (42.9% vs 4.8%, P=.011). Long-term mortality was 53.3% among patients with baseline MELD≥20 and 7.5% among those with MELD<20 (P<.0001). Among deceased patients 75% were Child-Turcotte-Pugh class C at baseline, while among survivors 83.9% were class A or B (P<.0001). Direct acting antivirals-based treatments for severe post-transplant hepatitis C recurrence, comprising fibrosing cholestatic hepatitis, significantly improve liver function, even without viral clearance and permit an excellent long-term survival. The setting of severe HCV recurrence may require the identification of "too-sick-to-treat patients" to avoid futile treatments.
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Affiliation(s)
- R Vukotic
- Centro di Ricerca per lo Studio delle Epatiti, Dipartimento di Scienze Mediche e Chirurgiche, Università degli Studi di Bologna, Bologna, Italy
| | - F Conti
- Centro di Ricerca per lo Studio delle Epatiti, Dipartimento di Scienze Mediche e Chirurgiche, Università degli Studi di Bologna, Bologna, Italy
| | - S Fagiuoli
- Dipartimento di Medicina Specialistica e dei Trapianti, U.S.C. Gastroenterologia Epatologia e Trapiantologia, Azienda Ospedaliera Papa Giovanni XXIII, Bergamo, Italy
| | - M C Morelli
- Centro di Ricerca per lo Studio delle Epatiti, Dipartimento di Scienze Mediche e Chirurgiche, Università degli Studi di Bologna, Bologna, Italy
| | - L Pasulo
- Dipartimento di Medicina Specialistica e dei Trapianti, U.S.C. Gastroenterologia Epatologia e Trapiantologia, Azienda Ospedaliera Papa Giovanni XXIII, Bergamo, Italy
| | - M Colpani
- Dipartimento di Medicina Specialistica e dei Trapianti, U.S.C. Gastroenterologia Epatologia e Trapiantologia, Azienda Ospedaliera Papa Giovanni XXIII, Bergamo, Italy
| | - F G Foschi
- AUSL della Romagna, Presidio Ospedaliero di Faenza, Faenza, Italy
| | - S Berardi
- Centro di Ricerca per lo Studio delle Epatiti, Dipartimento di Scienze Mediche e Chirurgiche, Università degli Studi di Bologna, Bologna, Italy
| | - P Pianta
- Centro di Ricerca per lo Studio delle Epatiti, Dipartimento di Scienze Mediche e Chirurgiche, Università degli Studi di Bologna, Bologna, Italy
| | - M Mangano
- Centro di Ricerca per lo Studio delle Epatiti, Dipartimento di Scienze Mediche e Chirurgiche, Università degli Studi di Bologna, Bologna, Italy
| | - M F Donato
- Gastroenterologia ed Epatologia, Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico ed Univerisità di Milano, Milan, Italy
| | - F Malinverno
- Gastroenterologia ed Epatologia, Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico ed Univerisità di Milano, Milan, Italy
| | - S Monico
- Gastroenterologia ed Epatologia, Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico ed Univerisità di Milano, Milan, Italy
| | - M Tamè
- Centro di Ricerca per lo Studio delle Epatiti, Dipartimento di Scienze Mediche e Chirurgiche, Università degli Studi di Bologna, Bologna, Italy
| | - G Mazzella
- Centro di Ricerca per lo Studio delle Epatiti, Dipartimento di Scienze Mediche e Chirurgiche, Università degli Studi di Bologna, Bologna, Italy
| | - L S Belli
- Dipartimento di Epatologia e Gastroenterologia, Ospedale Niguarda, Milan, Italy
| | - R Viganò
- Dipartimento di Epatologia e Gastroenterologia, Ospedale Niguarda, Milan, Italy
| | - P Carrai
- Chirurgia biliopancreatica e Trapianto di Fegato, Università di Pisa, Pisa, Italy
| | - P Burra
- Dipartimento di Chirurgia, Oncologia e Gastroenterologia, Unità di Trapianto Multiviscerale, Ospedale Universitario Padova, Padua, Italy
| | - F P Russo
- Dipartimento di Chirurgia, Oncologia e Gastroenterologia, Unità di Trapianto Multiviscerale, Ospedale Universitario Padova, Padua, Italy
| | - I Lenci
- Unità di Epatologia, Università Tor Vergata, Rome, Italy
| | - P Toniutto
- Medicina Interna Sezione di Trapianto di Fegato, Università di Udine, Udine, Italy
| | - M Merli
- Dipartimento di Medicina Clinica La Sapienza, Gastroenterologia, Università di Roma, Rome, Italy
| | | | - R Iemmolo
- Chirurgia Oncologica Epato-bilio-pancreatica e Chirurgia dei Trapianti di fegato, AOU di Modena, Modena, Italy
| | - A M Degli Antoni
- Unità di Malattie Infettive ed Epatologia, AOU di Parma, Parma, Italy
| | - A Romano
- Dipartimento di Medicina, Unità delle Emergenze epatologiche e dei Trapianti di fegato, Università di Padova, Padua, Italy
| | - A Picciotto
- Dipartimento di Medicina Interna, Università degli Studi di Genova, Genova, Italy
| | - M Rendina
- Unità Operativa Gastroenterologia ed Endoscopia Digestiva, Policlinico Universitario di Bari, Bari, Italy
| | - P Andreone
- Centro di Ricerca per lo Studio delle Epatiti, Dipartimento di Scienze Mediche e Chirurgiche, Università degli Studi di Bologna, Bologna, Italy
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Anand AC, Agarwal SK, Garg HK, Khanna S, Gupta S. Sofosbuvir and Ribavirin for 24 Weeks Is An Effective Treatment Option for Recurrent Hepatitis C Infection After Living Donor Liver Transplantation. J Clin Exp Hepatol 2017; 7:165-171. [PMID: 28970701 PMCID: PMC5620355 DOI: 10.1016/j.jceh.2017.06.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2017] [Accepted: 06/19/2017] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Recurrent hepatitis C virus (HCV) has been a serious problem after liver transplantation (LT). We report our experience of 24-week therapy with sofosbuvir (SOF) and ribavirin (RBV) in post-LT recurrent HCV in living donor liver transplantation (LDLT) setting in South Asia. METHODS Data from all patients treated for post-transplantation HCV recurrence in a single center were analyzed. Treatment regimen was 24 weeks of SOF 400 mg daily and RBV (starting at 800 mg daily, increased as tolerated). Sustained virological response (SVR) was assessed 12 weeks and 24 weeks after completion of treatment. RESULTS 63 patients (median age 52 [range 30-69] years; 80% males) were treated. Most (76.2%) were treatment experienced and predominant HCV genotype was 3 (77.7%) followed by 1 (20.6%). Median transient elastography (Fibroscan) score was 7 (range 3-11) kPa and none of the patients had cirrhosis. SVR12 was achieved in 60 of 63 patients (95.2%) while SVR24 was noted in 59 (93.7%). SVR12 rates were as good in genotype-3 as in genotype-1. Older age, longer period after transplantation, higher Fibroscan value and higher need for erythropoietin were likely to be associated with relapse. Adverse effects were noted in 34 patients and weakness and fatigue were the commonest side effects. Significant drop in hemoglobin (<8 g/dL) was seen in 6 patients. CONCLUSIONS SOF + RBV combination therapy for 24 weeks was safe and effective in treatment of for post-LT recurrent HCV in a single LT center and remains relevant due to its low cost and lack of drug interactions.
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Key Words
- CBC, complete blood counts
- DAA, directly acting antivirals
- HCC, hepatocellular carcinoma
- HCV, hepatitis C virus
- Hb%, hemoglobin
- KFT, kidney function tests
- LDLT, living donor liver transplantation
- LFT, liver function tests
- LT, liver transplantation
- RBV, ribavirin
- SOF, sofosbuvir
- SVR, sustained virological response
- g/dL, grams per decilitre
- genotype-1
- genotype-3
- kPA, kilo pascals
- living donor liver transplantation
- recurrent hepatitis C
- sustained viral response
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Affiliation(s)
- Anil C. Anand
- Department of Hepatology & Gastroenterology, Indraprastha Apollo Hospital, Sarita Vihar, Mathura Road, New Delhi 110076, India
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Broschewitz J, Wiltberger G, Krezdorn N, Krenzien F, Förster J, Atanasov G, Hau HM, Schmelzle M, Hinz A, Bartels M, Benzing C. Primary liver transplantation and liver retransplantation: comparison of health-related quality of life and mental status - a cross-sectional study. Health Qual Life Outcomes 2017; 15:147. [PMID: 28732511 PMCID: PMC5521060 DOI: 10.1186/s12955-017-0723-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Accepted: 07/17/2017] [Indexed: 12/16/2022] Open
Abstract
Background Liver Retransplantation (Re-LT) procedures are associated with an increased risk of morbidity and mortality. Up to date, there is no knowledge on the health-related quality of life and the mental status of these patients. Methods Health-Related Quality of Life (HRQoL) was assessed by using the Short Form 36 (SF-36) Health Survey and Mental Status was assessed by using the Hospital Anxiety and Depression Scale (HADS). The patients were examined in different assessments: During regular check-up examinations in the LT outpatient department in 2011 (Survey 1) and in a postal survey in 2013 (Survey 2). Their medical data was collected by using an established database. Results We received eligible surveys of 383 patients (55.6%) with a history of LT, of which 15 (3.9%) had undergone Re-LT (Re-LT group). These patients were compared to a group of 60 patients who had undergone only one LT. With regard to their HRQoL, the Re-LT group had significantly lower scores on the scales of physical function (PF, p = 0.026), their role-physical (RP, p = 0.008), their vitality (VIT, p = 0.040), and their role-emotional (RE, p = 0.005). The scores for anxiety and depression did not differ significantly between the groups. In a multiple regression analysis, chronic kidney disease was found to be an independent risk factor for decreased scores of PF (p = 0.023). Conclusions Patients who have to undergo Re-LT procedures are faceing impairments in physical aspects of a HRQoL. Together with clinical results from other studies, the findings of the present examination underline the need for an optimized organ distribution strategy since not all patients listed for Re-LT appear to benefit from it.
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Affiliation(s)
- Johannes Broschewitz
- Department of Visceral, Thoracic, Transplantation and Vascular Surgery, University Hospital Leipzig, Leipzig, Germany
| | - Georg Wiltberger
- Department of Visceral, Thoracic, Transplantation and Vascular Surgery, University Hospital Leipzig, Leipzig, Germany
| | - Nicco Krezdorn
- Department of Plastic, Hand and Reconstructive Surgery, Hannover Medical School, Hannover, Germany
| | - Felix Krenzien
- Department of Surgery, Campus Virchow and Campus Mitte, Charité-Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Julia Förster
- Department of Visceral, Thoracic, Transplantation and Vascular Surgery, University Hospital Leipzig, Leipzig, Germany
| | - Georgi Atanasov
- Department of Surgery, Campus Virchow and Campus Mitte, Charité-Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Hans-Michael Hau
- Department of Visceral, Thoracic, Transplantation and Vascular Surgery, University Hospital Leipzig, Leipzig, Germany
| | - Moritz Schmelzle
- Department of Surgery, Campus Virchow and Campus Mitte, Charité-Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Andreas Hinz
- Department of Medical Psychology and Medical Sociology, University Hospital Leipzig, Leipzig, Germany
| | - Michael Bartels
- Department of Visceral, Thoracic, Transplantation and Vascular Surgery, University Hospital Leipzig, Leipzig, Germany
| | - Christian Benzing
- Department of Surgery, Campus Virchow and Campus Mitte, Charité-Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany.
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Berge E, Otón E, Reina Z, Díaz L, Márquez A, Cejas L, Acosta S, Pérez F. Predictors of Poor Prognosis in Recurrent Hepatitis C After Liver Transplantation. Transplant Proc 2017; 48:2997-2999. [PMID: 27932129 DOI: 10.1016/j.transproceed.2016.07.043] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Accepted: 07/27/2016] [Indexed: 02/07/2023]
Abstract
BACKGROUND Hepatitis C is a common indication for liver transplantation (LT). Hepatitis C virus (HCV) recurrence is universal in viremic patients. This recurrence is frequently very aggressive, with graft loss in less than 5 years. Our aim is to detect which factors are related to worse fibrosis at 1 year post-LT. PATIENTS AND METHODS Records of all HCV-positive transplanted patients in Hospital Universitario Nuestra Señora de la Candelaria from 1996 to 2014 were collected. The variables analyzed were donor and recipient age and gender, hypertension, diabetes, viral genotype, viral load at LT, hepatocellular carcinoma in the explant, anticoagulation or antiplatelet treatment, year of transplantation, and mean levels of tacrolimus in the first month. Severe recurrence was defined as fibrosis F3 by biopsy, liver stiffness > 9.5 kPa by transient elastography, or hepatic venous pressure gradient > 5 mm Hg at 1 year post-LT. Univariate and multivariate analyses were performed. RESULTS From a sample of 112 patients, 88 patients met inclusion criteria. Mean recipient age was 52.8 ± 8.0 years and 70.5% were men. Mean donor age was 46.4 ± 16.1 years and 59.1% were men. Severe recurrence occurred in 23.9%. Univariate analyses showed 3 variables were statistically significant: donor age (P = .03), recipient age (P = .008), and presence of hepatocellular carcinoma (P = .01). Only the 2 first variables remained significant in the multivariate model (P = .009 and P = .044 respectively). Hepatocellular carcinoma was probably related to older recipients becoming a confounding factor. CONCLUSIONS In our study, donor and recipient age both conferred a worse prognosis in terms of fibrosis progression in patients with liver transplant due to HCV.
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Affiliation(s)
- E Berge
- Liver Transplantation Unit, Hospital Universitario Nuestra Señora de la Candelaria, Santa Cruz de Tenerife, Spain
| | - E Otón
- Liver Transplantation Unit, Hospital Universitario Nuestra Señora de la Candelaria, Santa Cruz de Tenerife, Spain.
| | - Z Reina
- Occupational Medicine Unit, Hospital Universitario de Canarias, Santa Cruz de Tenerife, Spain
| | - L Díaz
- Liver Transplantation Unit, Hospital Universitario Nuestra Señora de la Candelaria, Santa Cruz de Tenerife, Spain
| | - A Márquez
- Liver Transplantation Unit, Hospital Universitario Nuestra Señora de la Candelaria, Santa Cruz de Tenerife, Spain
| | - L Cejas
- Liver Transplantation Unit, Hospital Universitario Nuestra Señora de la Candelaria, Santa Cruz de Tenerife, Spain
| | - S Acosta
- Liver Transplantation Unit, Hospital Universitario Nuestra Señora de la Candelaria, Santa Cruz de Tenerife, Spain
| | - F Pérez
- Liver Transplantation Unit, Hospital Universitario Nuestra Señora de la Candelaria, Santa Cruz de Tenerife, Spain
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van Tilborg M, Maan R, van der Meer AJ, de Knegt RJ. Interferon-free antiviral therapy for chronic hepatitis C among patients in the liver transplant setting. Best Pract Res Clin Gastroenterol 2017. [PMID: 28624110 DOI: 10.1016/j.bpg.2017.04.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Chronic hepatitis C (HCV) infection remains a major public health problem with many infected individuals worldwide. The revolutionary discovery of highly effective direct-acting antivirals (DAAs) makes chronic HCV infection a curable disease, even in patients with advanced liver disease. Liver function may improve shortly after initiation of antiviral therapy in patients on the waiting list and could even obviate the need for transplantation. However, whether these short term benefits also result in a favorable prognosis on the long-term remains to be seen and this fuels the discussion whether DAAs should be used prior to liver transplantation in all patients. Following liver transplantation, DAA treatment is also highly effective so that postponing antiviral treatment to the post-transplant setting may be better for certain patients. Furthermore, the discussion whether HCV positive organ donors should be used now viral eradication is achieved in almost all patients has regained interest.
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Affiliation(s)
| | - Raoel Maan
- Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
| | | | - Robert J de Knegt
- Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
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Abstract
Cirrhosis due to chronic hepatitis C (HCV) is the leading indication for liver transplantation in North America and Europe. HCV re-infection post-transplant is nearly universal and if left untreated negatively affects patient and graft survival. Until recently, treatment options for HCV were limited to interferon (IFN)-based therapies which had low sustained viral response (SVR) rates and were poorly tolerated in the post-transplant setting. In the last 3 years, the promise of the directly acting antivirals (DAAs) for the treatment of HCV has been fulfilled with high sustained viral response (SVR) rates and a low side effect profile demonstrated in both registration trials and real-world studies. This innovation has allowed post-liver transplant patients with HCV recurrence access to interferon-free therapies with extraordinary efficacy, safety, tolerability, and fewer drug-drug interactions.
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Anand AC. Potential Liver Transplant Recipients with Hepatitis C: Should They Be Treated Before or After Transplantation? J Clin Exp Hepatol 2017; 7:42-54. [PMID: 28348470 PMCID: PMC5357718 DOI: 10.1016/j.jceh.2017.01.116] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Accepted: 01/31/2017] [Indexed: 12/12/2022] Open
Abstract
Treatment of hepatitis C virus (HCV) with newer directly acting antivirals (DAAs) and lead to sustained viral response (SVR) in majority of patients and SVR has been documented to be associated with reversal of liver cirrhosis. The improved SVR rates and safety profiles of DAAs have led to the treatment of patients with decompensated cirrhosis awaiting liver transplantation (LT). Several clinical trials of DAAs in decompensated HCV patients have recently demonstrated SVR rates above 80%, which have been associated with significant improvements, in the Child-Pugh-Turcotte scores/or model for end-stage liver disease scores in a proportion of patients. Moreover, it has been shown that HCV RNA becomes negative after 2-4 weeks of treatment, and those who are transplanted after becoming HCV RNA negative will be have very low the risk of HCV recurrence after transplantation. Some of the patients may have reached the "point of no return" and may proceed to worsening of decomposition over time. To avoid the risk of worsening, there is an additional option of treating these patients after LT should they develop recurrent HCV infection. Currently there are no guidelines as to select patients who would benefit from treatment prior to LT as opposed to those who will be better off being treated after the transplant surgery. The article discusses a possible approach for such selection.
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Key Words
- CSA, cyclosporine A
- CTP, Child–Turcotte–Pugh staging
- DAA, directly acting antivirals
- DCV, daclatasvir
- DDLT, deceased donor liver transplant
- DSB, dasabuvir
- EBV, elbasvir
- FCH, fibrosing cholestatic hepatitis
- GRZ, grazoprevir
- GT, genotype
- HCV, hepatitis C virus
- IU, international units
- LDLT, living donor liver transplant
- LDV, ledipasvir
- LT, liver transplantation
- MELD, model for end-stage liver disease RNA
- OMB, ombitasvir
- PTV, paritaprevir
- Peg-IFN, pegylated interferon alfa
- RBV, ribavirin
- SMV, simeprevir
- SOF, sofosbuvir
- SVR, sustained virological response, (SVR 12 signifies SVR at 12 weeks)
- TAC, tacrolimus
- VLP, velpatasvir
- decompensated cirrhosis
- directly acting antivirals
- hepatitis C virus infection
- liver transplantation
- rt, ritonavir
- sustained virological response
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Affiliation(s)
- Anil C. Anand
- Indraprastha Apollo Hospital, Sarita Vihar, New Delhi, India
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35
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Naggie S, Muir AJ. Oral Combination Therapies for Hepatitis C Virus Infection: Successes, Challenges, and Unmet Needs. Annu Rev Med 2017; 68:345-358. [PMID: 27686017 DOI: 10.1146/annurev-med-052915-015720] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
The current standard of care for the treatment of hepatitis C virus (HCV) consists of interferon-free direct-acting antiviral (DAA) regimens, including combinations of DAAs and fixed-dose combination pills. DAAs for HCV are likely to be heralded as one of medicine's greatest advancements. Viral eradication rates are pushing 100% for many HCV-infected populations, including patients with HIV/HCV coinfection, decompensated cirrhosis, liver and kidney transplants, and end-stage liver disease. We highlight the greatest successes of combination DAA therapies, discuss the ongoing challenges, and identify the remaining patient subgroups with unmet medical needs.
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Affiliation(s)
- Susanna Naggie
- Duke University School of Medicine and Duke Clinical Research Institute, Durham, North Carolina 27715;
| | - Andrew J Muir
- Duke University School of Medicine and Duke Clinical Research Institute, Durham, North Carolina 27715;
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36
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Park JY. Strategy for Hepatitis C Treatment in Liver Transplant Settings. KOREAN JOURNAL OF TRANSPLANTATION 2016. [DOI: 10.4285/jkstn.2016.30.4.149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Jun Yong Park
- Department of Internal Medicine, Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Korea
- Yonsei Liver Center, Yonsei University Health System, Seoul, Korea
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37
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Zhang Y. Impact of Donor Recipient Gender and Race Mismatch on Graft Outcomes in Patients With End-Stage Liver Disease Undergoing Liver Transplantation. Prog Transplant 2016; 27:39-47. [PMID: 27895103 DOI: 10.1177/1526924816679839] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
CONTEXT The discrepancy between donor supply and organ demand increased the possibility of gender and race mismatch between the donors and recipients. However, the findings of their impact on graft and patient survival are outdated and mixed. OBJECTIVE To estimate the effects of gender and race mismatch on graft survival and patient survival among adult patients (18 years and older) with end-stage liver disease. DESIGN A total of 38 768 patients undergoing liver transplant between 2002 and 2011 were identified from United Network for Organ Sharing database. Kaplan-Meier curves, log-rank tests, and Cox proportional hazard regressions with backward elimination adopting a marginal approach with a working independence assumption and stratification on recipient hepatitis C virus status were used. MAIN OUTCOME MEASURES Posttransplantation graft survival and patient survival. RESULTS Both gender mismatch (hazard ratio [HR]: 1.14, 95% confidence interval [CI]: 1.09-1.12) and race mismatch (HR 1.08, 95%C: 1.04-1.12) had significantly adverse effects on graft survival and patient survival after controlling for other factors, especially among hepatitis C-positive female recipients with male donors (HR 1.13, 95%CI 1.03-1.24), black recipients with white donors (1.39, 1.29-1.49) or Hispanic donors (HR 1.48, 95%CI 1.27-1.72), and these effects were even worse among hepatitis C-positive recipients. CONCLUSION Gender and race mismatch between donors and recipients adversely affected graft survival and patient survival among adult patients with end-stage liver disease, both independently and after the adjustment for other factors. Future research is recommended to explore other factors such as new model for end-stage liver disease sharing policy change and disparities in access to waiting-list or transplantation.
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Affiliation(s)
- Yefei Zhang
- 1 Department of Biostatistics, School of Public Health, University of Texas Health Science Center, Houston, TX, USA
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38
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Tawar RG, Heydmann L, Bach C, Schüttrumpf J, Chavan S, King BJ, McClure CP, Ball JK, Pessaux P, Habersetzer F, Bartenschlager R, Zeisel MB, Baumert TF. Broad neutralization of hepatitis C virus-resistant variants by Civacir hepatitis C immunoglobulin. Hepatology 2016; 64:1495-1506. [PMID: 27531416 PMCID: PMC7615276 DOI: 10.1002/hep.28767] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2016] [Accepted: 07/19/2016] [Indexed: 12/15/2022]
Abstract
Hepatitis C virus (HCV)-induced end-stage liver disease is the major indication for liver transplantation (LT). However, reinfection of the liver graft is still common, especially in patients with detectable viral load at the time of LT. Limited data are available on direct-acting antivirals in the transplant setting for prevention of graft infection. The human hepatitis C immunoglobulin (HCIG) Civacir is an investigational drug that is currently being developed in an ongoing phase 3 clinical trial assessing its safety and efficacy at preventing HCV recurrence after liver transplantation (LT) in the United States. Using well-characterized patient-derived HCV variants selected during LT, we studied the molecular mechanism of action of Civacir. Inhibition of HCV infection was studied using infectious HCV models including HCV pseudoparticles (HCVpp) and cell culture-derived HCV (HCVcc) containing patient-derived viral envelope glycoproteins from 22 HCV variants isolated from patients before and after LT. The human hepatitis C immune globulin Civacir is an investigational drug that is currently being developed in an ongoing phase 3 clinical trial assessing safety and efficacy to prevent HCV recurrence after LT in the United States. Using well-characterized patient-derived HCV variants selected during LT, we studied the molecular mechanism of action of Civacir. Inhibition of HCV infection was studied using infectious HCV models including HCV pseudoparticles and cell culture-derived HCV containing patient-derived viral envelope glycoproteins from 22 HCV variants isolated from patients before and after liver transplantation. Additionally, we studied neutralization of different HCV genotypes and of direct-acting antiviral-resistant viruses. Our results indicate that Civacir potently, broadly, and dose-dependently neutralizes all tested patient variants in HCV pseudoparticles and cell culture-derived HCV assays including variants displaying resistance to host neutralizing antibodies and antiviral monoclonal antibodies. The half-maximal inhibitory concentrations were independent of the phenotype of the viral variant, indicating that virus neutralization by Civacir is not affected by viral selection. Furthermore, Civacir is equally active against tested direct-acting antiviral-resistant HCV isolates in cell culture. CONCLUSION Collectively, these results demonstrate broad neutralizing activity of Civacir against resistant viruses, likely due to synergy between anti-HCV antibodies derived from different plasma donors, and support its further clinical development for prevention of liver graft infection. (Hepatology 2016;64:1495-1506).
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Affiliation(s)
- Rajiv G Tawar
- Inserm U1110, Institut de Recherche sur les Maladies Virales et Hépatiques, Strasbourg, France
- University of Strasbourg, Strasbourg, France
| | - Laura Heydmann
- Inserm U1110, Institut de Recherche sur les Maladies Virales et Hépatiques, Strasbourg, France
- University of Strasbourg, Strasbourg, France
| | - Charlotte Bach
- Inserm U1110, Institut de Recherche sur les Maladies Virales et Hépatiques, Strasbourg, France
- University of Strasbourg, Strasbourg, France
| | | | | | - Barnabas J King
- School of Life Sciences and the NIHR Nottingham Digestive Diseases Biomedical Research Unit, University of Nottingham, Queen's Medical Centre, Nottingham, UK
| | - C Patrick McClure
- School of Life Sciences and the NIHR Nottingham Digestive Diseases Biomedical Research Unit, University of Nottingham, Queen's Medical Centre, Nottingham, UK
| | - Jonathan K Ball
- School of Life Sciences and the NIHR Nottingham Digestive Diseases Biomedical Research Unit, University of Nottingham, Queen's Medical Centre, Nottingham, UK
| | - Patrick Pessaux
- Inserm U1110, Institut de Recherche sur les Maladies Virales et Hépatiques, Strasbourg, France
- University of Strasbourg, Strasbourg, France
- Institut Hospitalo-universitaire, Pôle Hépato-digestif, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - François Habersetzer
- Inserm U1110, Institut de Recherche sur les Maladies Virales et Hépatiques, Strasbourg, France
- University of Strasbourg, Strasbourg, France
- Institut Hospitalo-universitaire, Pôle Hépato-digestif, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Ralf Bartenschlager
- Department of Infectious Diseases, Molecular Virology, Heidelberg University, Heidelberg, Germany
- German Center for Infection Research, Heidelberg University, Heidelberg, Germany
| | - Mirjam B Zeisel
- Inserm U1110, Institut de Recherche sur les Maladies Virales et Hépatiques, Strasbourg, France
- University of Strasbourg, Strasbourg, France
| | - Thomas F Baumert
- Inserm U1110, Institut de Recherche sur les Maladies Virales et Hépatiques, Strasbourg, France.
- University of Strasbourg, Strasbourg, France.
- Institut Hospitalo-universitaire, Pôle Hépato-digestif, Hôpitaux Universitaires de Strasbourg, Strasbourg, France.
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Dumortier J, Leroy V, Duvoux C, de Ledinghen V, Francoz C, Houssel-Debry P, Radenne S, d'Alteroche L, Fougerou-Leurent C, Canva V, di Martino V, Conti F, Kamar N, Moreno C, Lebray P, Tran A, Besch C, Diallo A, Rohel A, Rossignol E, Abergel A, Botta-Fridlund D, Coilly A, Samuel D, Duclos-Vallée JC, Pageaux GP. Sofosbuvir-based treatment of hepatitis C with severe fibrosis (METAVIR F3/F4) after liver transplantation. Liver Transpl 2016; 22:1367-78. [PMID: 27348086 DOI: 10.1002/lt.24505] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Revised: 05/24/2016] [Accepted: 05/31/2016] [Indexed: 12/12/2022]
Abstract
Recurrence of hepatitis C virus (HCV) after liver transplantation (LT) can rapidly lead to liver graft cirrhosis and, therefore, graft failure and retransplantation or death. The aim of the present study was to assess efficacy and tolerance of sofosbuvir (SOF)-based regimens for the treatment of HCV recurrence in patients with severe fibrosis after LT. The Compassionate Use of Protease Inhibitors in Viral C Liver Transplantation (CULPIT) study is a prospective multicenter cohort including patients with HCV recurrence following LT treated with second generation direct antivirals. The present study focused on patients included between October 2013 and November 2014 and diagnosed with HCV recurrence and liver graft extensive fibrosis (METAVIR F3/F4). A SOF-based regimen was administered to 125 patients fulfilling inclusion criteria. The median delay from LT was 95.9 ± 69.6 months. The characteristics of patients were as follows: mean age, 59.4 ± 9.0 years; 78.4% male; infected by HCV genotype 1: 78.2%, mean HCV RNA: 6.1 ± 1.0 log10 IU/mL. Eighty patients had failed previous post-LT antiviral therapy (64.0%) including triple therapy with first generation protease inhibitors in 19 (15.2%) patients. The main combination regimen was SOF/daclatasvir (73.6%). Ribavirin was used in 60 patients. Sustained virological response 12 weeks after treatment was 92.8% (on an intention-to-treat basis); 7 patients with virological failure were observed. Serious adverse events occurred in 25.6% of the patients during antiviral treatment. During antiviral treatment and follow-up, 3 patients were retransplanted and 4 patients died. In conclusion, SOF-based antiviral treatment shows very promising results in patients with HCV recurrence and severe fibrosis after LT. Liver Transplantation 22 1367-1378 2016 AASLD.
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Affiliation(s)
- Jérôme Dumortier
- Hospices Civils de Lyon, Hôpital Edouard Herriot, Université Claude Bernard Lyon 1, Lyon, France.
| | - Vincent Leroy
- Pôle Digidune, Clinique Universitaire d'Hépato-Gastroentérologie, Centre Hospitalier Universitaire de Grenoble, INSERM/Université Grenoble Alpes U823, Institut Albert Bonniot, Grenoble, France
| | | | - Victor de Ledinghen
- Service d'Hépatologie, Hôpital Haut-Lévêque, Centre Hospitalier Universitaire de Bordeaux, INSERM U1053, Université Bordeaux, Bordeaux, France
| | - Claire Francoz
- Service d'Hépatologie, Hôpital Beaujon, AP-HP, Université Paris Diderot et INSERM U1149, Centre de Recherche sur l'Inflammation, Clichy, France
| | - Pauline Houssel-Debry
- Service des Maladies du Foie, Centre Hospitalier Universitaire de Rennes, Rennes, France
| | - Sylvie Radenne
- Service d'Hépatologie, Hôpital de la Croix Rousse, Hospices Civils de Lyon, Lyon, France
| | - Louis d'Alteroche
- Service d'hépato-gastroentérologie, Centre Hospitalier Universitaire Trousseau, Tours, France
| | - Claire Fougerou-Leurent
- Unité de Pharmacologie Clinique, Centre Hospitalier Universitaire de Rennes, Centre d'Investigation Clinique INSERM 1414, Rennes, France
| | - Valérie Canva
- Services Maladies de l'Appareil Digestif, Hôpital Claude Huriez, Centre Hospitalier Universitaire de Lille, Lille, France
| | - Vincent di Martino
- Service d'Hépatologie, Hôpital Jean Minjoz, Centre Hospitalier Universitaire de Besançon, Université de Franche Comté, Besançon, France
| | - Filomena Conti
- Service d'hépato-gastroentérologie, Groupe Hospitalier Pitié-Salpétrière, AP-HP, Université Pierre et Marie Curie Paris 6, INSERM Unités Mixtes de Recherche S938, Paris, France
| | - Nassim Kamar
- Département de Néphrologie et de Transplantation d'Organes, Centre Hospitalier Universitaire Rangueil, Université de Toulouse, Toulouse, France
| | - Christophe Moreno
- Cliniques Universitaires de Bruxelles, Hôpital Erasme, Université Libre de Bruxelles, Bruxelles, Belgium
| | - Pascal Lebray
- Service d'hépato-gastroentérologie, Groupe Hospitalier Pitié-Salpétrière, AP-HP, Université Pierre et Marie Curie Paris 6, INSERM Unités Mixtes de Recherche S938, Paris, France
| | - Albert Tran
- Service d'Hépatologie, Hôpital de l'Archet 2, Centre Hospitalier Universitaire de Nice, INSERM U1065, Université de Nice-Sophia-Antipolis, Nice, France
| | - Camille Besch
- Service de Transplantation, Centre Hospitalier Universitaire de Strasbourg, Strasbourg, France
| | - Alpha Diallo
- Unit for Basic and Clinical Research on Viral Hepatitis, France Recherche Nord&Sud Sida-HIV Hépatites, Agence Nationale de Recherche sur le Sida, Paris, France
| | - Alexandra Rohel
- Unit for Basic and Clinical Research on Viral Hepatitis, France Recherche Nord&Sud Sida-HIV Hépatites, Agence Nationale de Recherche sur le Sida, Paris, France
| | - Emilie Rossignol
- Unité de Pharmacologie Clinique, Centre Hospitalier Universitaire de Rennes, Centre d'Investigation Clinique INSERM 1414, Rennes, France
| | - Armand Abergel
- Service d'Hépato-Gastroentérologie, Centre Hospitalier Universitaire Estaing, Université d'Auvergne, Unités Mixtes de Recherche CNRS 6284, Clermont-Ferrand, France
| | | | - Audrey Coilly
- Centre Hépato-Biliaire, Hôpital Paul Brousse, AP-HP, Université Paris-Sud, Université Paris-Saclay, UMR-S 1193, INSERM Unité 1193, Département Hospitalo-Universitaire Hepatinov, Villejuif, France
| | - Didier Samuel
- Centre Hépato-Biliaire, Hôpital Paul Brousse, AP-HP, Université Paris-Sud, Université Paris-Saclay, UMR-S 1193, INSERM Unité 1193, Département Hospitalo-Universitaire Hepatinov, Villejuif, France
| | - Jean-Charles Duclos-Vallée
- Centre Hépato-Biliaire, Hôpital Paul Brousse, AP-HP, Université Paris-Sud, Université Paris-Saclay, UMR-S 1193, INSERM Unité 1193, Département Hospitalo-Universitaire Hepatinov, Villejuif, France
| | - Georges-Philippe Pageaux
- Département d'Hépato-Gastroentérologie et de Transplantation Hépatique, Centre Hospitalier Universitaire Saint-Eloi, Université de Montpellier, Montpellier, France
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40
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Alavian SM, Hajarizadeh B, Bagheri Lankarani K, Sharafi H, Ebrahimi Daryani N, Merat S, Mohraz M, Mardani M, Fattahi MR, Poustchi H, Nikbin M, Nabavi M, Adibi P, Ziaee M, Behnava B, Rezaee-Zavareh MS, Colombo M, Massoumi H, Bizri AR, Eghtesad B, Amiri M, Namvar A, Hesamizadeh K, Malekzadeh R. Recommendations for the Clinical Management of Hepatitis C in Iran: A Consensus-Based National Guideline. HEPATITIS MONTHLY 2016; 16:e40959. [PMID: 27799966 PMCID: PMC5075356 DOI: 10.5812/hepatmon.guideline] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/31/2016] [Accepted: 07/31/2016] [Indexed: 02/07/2023]
Abstract
CONTEXT Hepatitis C virus (HCV) infection is a major public health issue worldwide, including Iran. The new direct-acting antiviral agents (DAAs) with high efficacy have changed the landscape of HCV treatment. This guideline provides updated recommendations for clinical management of HCV infection in Iran. EVIDENCE ACQUISITION The recommendations of this guideline are based on international and national scientific evidences and consensus-based expert opinion. Scientific evidences were collected through a systematic review of studies that evaluated efficacy and safety of DAA regimens, using PubMed, Scopus and Web of Science. Expert opinion was based on the consensus of Iran Hepatitis Scientific Board (IHSB) in the 3rd national consensus on management of Hepatitis C in Iran, held on 22nd of July 2016. RESULTS Pegylated Interferon alpha (PegIFN), Ribavirin (RBV), Sofosbuvir (SOF), Ledipasvir (LDV) and Daclatasvir (DCV) are currently available in Iran. Pre-treatment assessments include HCV RNA level, HCV genotype and resistance testing, assessment of liver fibrosis, and underlying diseases. In HCV genotype 1 and 4, DCV/SOF and LDV/SOF are recommended. In HCV genotype 2, SOF plus RBV and in HCV genotype 3, DCV/SOF is recommended. Additional care for underlying diseases should be considered. CONCLUSIONS Affordable new HCV treatment regimens are available in Iran, providing an opportunity for HCV elimination. Recommendations provided in this current national guideline can facilitate evidence-based management of HCV infection.
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Affiliation(s)
- Seyed Moayed Alavian
- Baqiyatallah Research Center for Gastroenterology and Liver Diseases (BRCGL), Baqiyatallah University of Medical Sciences, Tehran, IR Iran
- Middle East Liver Diseases (MELD) Center, Tehran, IR Iran
- Corresponding Author: Seyed Moayed Alavian, Baqiyatallah Research Center for Gastroenterology and Liver Diseases (BRCGL), Baqiyatallah University of Medical Sciences, Tehran, IR Iran. Tel: +98-2181264070, E-mail:
| | - Behzad Hajarizadeh
- Viral Hepatitis Clinical Research Program, The Kirby Institute, The University of New South Wales (UNSW Australia), Sydney, Australia
| | | | - Heidar Sharafi
- Baqiyatallah Research Center for Gastroenterology and Liver Diseases (BRCGL), Baqiyatallah University of Medical Sciences, Tehran, IR Iran
- Middle East Liver Diseases (MELD) Center, Tehran, IR Iran
| | | | - Shahin Merat
- Liver and Pancreatobiliary Diseases Research Center, Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, IR Iran
| | - Minoo Mohraz
- Iranian Research Center for HIV/AIDS (IRCHA), Tehran University of Medical Sciences, Tehran, IR Iran
| | - Masoud Mardani
- Infectious Diseases and Tropical Medicine Research Center, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran
| | - Mohamad Reza Fattahi
- Gastroenterohepatology Research Center, Shiraz University of Medical Sciences, Shiraz, IR Iran
| | - Hossein Poustchi
- Liver and Pancreatobiliary Diseases Research Center, Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, IR Iran
| | - Mehri Nikbin
- Middle East Liver Diseases (MELD) Center, Tehran, IR Iran
| | - Mahmood Nabavi
- Department of Infectious Diseases and Tropical Medicine, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran
| | - Peyman Adibi
- Department of Gastroenterology and Hepatology, Isfahan University of Medical Sciences, Isfahan, IR Iran
| | - Masood Ziaee
- Hepatitis Research Center, Birjand University of Medical Sciences, Birjand, IR Iran
| | - Bita Behnava
- Baqiyatallah Research Center for Gastroenterology and Liver Diseases (BRCGL), Baqiyatallah University of Medical Sciences, Tehran, IR Iran
- Middle East Liver Diseases (MELD) Center, Tehran, IR Iran
| | - Mohammad Saeid Rezaee-Zavareh
- Baqiyatallah Research Center for Gastroenterology and Liver Diseases (BRCGL), Baqiyatallah University of Medical Sciences, Tehran, IR Iran
- Middle East Liver Diseases (MELD) Center, Tehran, IR Iran
- Student’s Research Committee, Baqiyatallah University of Medical Sciences, Tehran, IR Iran
| | - Massimo Colombo
- Department of Medicine, Gastroenterology Division 1, AM and A Migliavacca Center for the Study of Liver Disease, Ca’ Granda Ospedale Maggiore Policlinico, University of Milan, Italy
| | - Hatef Massoumi
- New York Associates in Gastroenterology, Bronx, New York, USA
| | - Abdul Rahman Bizri
- Division of Infectious Diseases, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | | | - Majid Amiri
- Gastroenterology and Hepatology Department, Gouin Hospital, Clichy, France
| | - Ali Namvar
- Department of Hepatitis and AIDS, Pasteur Institute of Iran, Tehran, IR Iran
| | - Khashayar Hesamizadeh
- Baqiyatallah Research Center for Gastroenterology and Liver Diseases (BRCGL), Baqiyatallah University of Medical Sciences, Tehran, IR Iran
- Middle East Liver Diseases (MELD) Center, Tehran, IR Iran
| | - Reza Malekzadeh
- Liver and Pancreatobiliary Diseases Research Center, Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, IR Iran
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Management of post liver transplantation recurrent hepatitis C infection with directly acting antiviral drugs: a review. Hepatol Int 2016; 10:749-61. [PMID: 27337961 DOI: 10.1007/s12072-016-9744-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Accepted: 05/17/2016] [Indexed: 12/20/2022]
Abstract
Recurrent HCV infection (rHCV) of the liver allograft following transplantation is universal and is associated with poor graft and patient survival in comparison with other indications. Treatment of rHCV infection in the previous era with pegylated interferon and ribavirin was associated with low sustained virological response (SVR) due to poor tolerability, adverse events and graft rejection. Recently, directly acting antiviral drugs (DAA) have been approved for the treatment of hepatitis C infection and a number of clinical trials have been conducted across various centers in the management of rHCV infection of the graft. In this review we discuss about recent studies that have emerged on the use of NS5b polymerase inhibitor, sofosbuvir in combination with second generation protease inhibitor, simeprevir, fixed dose ledipasvir or daclatasvir with or without ribavirin in the treatment of post transplant rHCV infection.
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42
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Felmlee DJ, Coilly A, Chung RT, Samuel D, Baumert TF. New perspectives for preventing hepatitis C virus liver graft infection. THE LANCET. INFECTIOUS DISEASES 2016; 16:735-745. [PMID: 27301929 PMCID: PMC4911897 DOI: 10.1016/s1473-3099(16)00120-1] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/14/2015] [Revised: 01/29/2016] [Accepted: 02/15/2016] [Indexed: 02/07/2023]
Abstract
Hepatitis C virus (HCV) infection is a leading cause of end-stage liver disease that necessitates liver transplantation. The incidence of virus-induced cirrhosis and hepatocellular carcinoma continues to increase, making liver transplantation increasingly common. Infection of the engrafted liver is universal and accelerates progression to advanced liver disease, with 20-30% of patients having cirrhosis within 5 years of transplantation. Treatments of chronic HCV infection have improved dramatically, albeit with remaining challenges of failure and access, and therapeutic options to prevent graft infection during liver transplantation are emerging. Developments in directed use of new direct-acting antiviral agents (DAAs) to eliminate circulating HCV before or after transplantation in the past 5 years provide renewed hope for prevention and treatment of liver graft infection. Identification of the ideal regimen and use of DAAs reveals new ways to treat this specific population of patients. Complementing DAAs, viral entry inhibitors have been shown to prevent liver graft infection in animal models and delay graft infection in clinical trials, which shows their potential for use concomitant to transplantation. We review the challenges and pathology associated with HCV liver graft infection, highlight current and future strategies of DAA treatment timing, and discuss the potential role of entry inhibitors that might be used synergistically with DAAs to prevent or treat graft infection.
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Affiliation(s)
- Daniel J Felmlee
- Inserm, U1110, Institut de Recherche sur les Maladies Virales et Hépatiques, Strasbourg, France; Université de Strasbourg, Strasbourg, France; Hepatology Research Group, Peninsula School of Medicine and Dentistry, University of Plymouth, Plymouth, UK
| | - Audrey Coilly
- AP-HP Hôpital Paul Brousse, Centre Hépato-Biliaire, Villejuif, France; University Paris-Sud, UMR-S 1193, Villejuif, France; Inserm Unit 1193, Villejuif F-94800, France
| | - Raymond T Chung
- Gastrointestinal Unit, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Didier Samuel
- AP-HP Hôpital Paul Brousse, Centre Hépato-Biliaire, Villejuif, France; University Paris-Sud, UMR-S 1193, Villejuif, France; Inserm Unit 1193, Villejuif F-94800, France.
| | - Thomas F Baumert
- Inserm, U1110, Institut de Recherche sur les Maladies Virales et Hépatiques, Strasbourg, France; Université de Strasbourg, Strasbourg, France; Gastrointestinal Unit, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; Institut Hospitalo-Universitaire, Pôle Hépato-digestif, Hôpitaux Universitaires de Strasbourg, Strasbourg, France.
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43
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Erard-Poinsot D, Guillaud O, Hervieu V, Thimonier E, Vallin M, Chambon-Augoyard C, Boillot O, Scoazec JY, Dumortier J. Severe alcoholic relapse after liver transplantation: What consequences on the graft? A study based on liver biopsies analysis. Liver Transpl 2016; 22:773-84. [PMID: 26929100 DOI: 10.1002/lt.24425] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Revised: 01/29/2016] [Accepted: 02/02/2016] [Indexed: 12/13/2022]
Abstract
Alcoholic liver disease (ALD) is a major indication for liver transplantation (LT), but up to 20% of patients experience severe alcoholic relapse. The aims of this study were to evaluate the impact of severe alcoholic relapse on the graft (based on histological examination) and to identify predictive factors associated with recurrent alcoholic cirrhosis (RAC). From 1990 to 2010, 369 patients underwent LT for ALD at Edouard Herriot Hospital (Lyon, France) and survived more than 1 year. All patients who presented severe alcoholic relapse and histological follow-up were included. Liver biopsies were performed at 1 and 5 years and at every 5 years after LT, and when clinically indicated. The median follow-up after LT was 11 years (range, 3-18 years). Severe alcoholic relapse was observed in 73 (20%) of the 369 patients, from whom 56 patients with histological evaluation were included. RAC was diagnosed in 18 (32%) of the 56 patients included, which represents 5% of the 369 patients transplanted for ALD. The median delay between LT and RAC was 6 years (range, 3-10 years) and 4.5 years (range, 2-8 years) after severe alcoholic relapse. The median cumulated years of alcohol use before RAC was 3.5 years (range, 2-7 years). The cumulative risk for F4 fibrosis was 15% at 3 years, 32% at 5 years, and 54% at 10 years after severe alcoholic relapse. A young age at LT (≤50 years old) and an early onset of heavy drinking (within the first 3 years after LT) were associated with RAC. In conclusion, severe alcoholic relapse usually occurs in the first years after LT and is responsible for accelerated severe graft injury. Liver Transplantation 22 773-784 2016 AASLD.
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Affiliation(s)
- Domitille Erard-Poinsot
- Fédération des Spécialités Digestives, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France.,Service d'Anatomie et Cytologie Pathologiques, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France
| | - Olivier Guillaud
- Fédération des Spécialités Digestives, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France
| | - Valérie Hervieu
- Service d'Anatomie et Cytologie Pathologiques, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France.,Université Claude Bernard Lyon 1, Villeurbanne, France
| | - Elsa Thimonier
- Fédération des Spécialités Digestives, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France
| | - Mélanie Vallin
- Fédération des Spécialités Digestives, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France
| | | | - Olivier Boillot
- Fédération des Spécialités Digestives, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France.,Université Claude Bernard Lyon 1, Villeurbanne, France
| | - Jean-Yves Scoazec
- Service d'Anatomie et Cytologie Pathologiques, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France.,Université Claude Bernard Lyon 1, Villeurbanne, France
| | - Jérôme Dumortier
- Fédération des Spécialités Digestives, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France.,Université Claude Bernard Lyon 1, Villeurbanne, France
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Bunchorntavakul C, Reddy KR. Treat chronic hepatitis C virus infection in decompensated cirrhosis - pre- or post-liver transplantation? the ironic conundrum in the era of effective and well-tolerated therapy. J Viral Hepat 2016; 23:408-18. [PMID: 27018088 DOI: 10.1111/jvh.12534] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Accepted: 03/01/2016] [Indexed: 12/12/2022]
Abstract
The management of hepatitis C virus (HCV) infection in patients with decompensated cirrhosis has evolved dramatically over the past few years mainly due to the availability of all-oral antiviral regimens. The currently approved all-oral direct-acting antivirals (DAA) containing sofosbuvir, ledipasvir, daclatasvir and ribavirin, in various combinations, have shown to be safe and effective in patients with decompensated cirrhosis with sustained virological response (SVR) rates nearly comparable to those with well-compensated liver disease. Unique issues yet remain such as the challenges with renal insufficiency, tolerability of ribavirin and risk of further hepatic decompensation with a protease inhibitor-based regimen. While most patients who achieve SVR have demonstrated improvement in hepatic synthetic function over the short course of follow, the long-term beneficial effects are unknown. Further, the baseline predictors of improvement in hepatic function have not been well delineated and thus have left us in a quandary as to what we might expect with successful therapy and thus we are at a loss to well educate our patients. The major concern, in potential liver transplant candidates, is of unintended 'harm' by achieving SVR but without improvement in hepatic function to an extent where the patients might function well. As HCV therapies are as effective in liver transplant recipients, there is a growing sentiment in some of the transplant quarters that those with decompensated liver disease and awaiting liver transplant be treated for HCV after liver transplant. This strategy would thus eliminate any concern of leaving a patient in 'no person's' land by treating HCV successfully pretransplant but not to the point of functional normalcy, while also would maintain the risk of HCC. Yet a contrarian view would be that not all patients have access to liver transplantation (LT), cannot bear the cost, have comorbidities or contraindications to LT. While the debate continues, it is essential that we develop robust predictors of improvement in liver function so that we can carefully select our patients for therapy in the context of liver transplantation.
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Affiliation(s)
- C Bunchorntavakul
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Rajavithi Hospital, College of Medicine, Rangsit University, Bangkok, Thailand
| | - K Rajender Reddy
- Division of Gastroenterology and Hepatology, University of Pennsylvania, Philadelphia, PA, USA
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45
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Two-Year Follow-Up Analysis of Telaprevir-Based Antiviral Triple Therapy for HCV Recurrence in Genotype 1 Infected Liver Graft Recipients as a First Step towards Modern HCV Therapy. HEPATITIS RESEARCH AND TREATMENT 2016; 2016:8325467. [PMID: 27195149 PMCID: PMC4852367 DOI: 10.1155/2016/8325467] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Accepted: 03/08/2016] [Indexed: 12/15/2022]
Abstract
Objective. The introduction of protease inhibitors telaprevir and boceprevir in 2011 had extended the antiviral treatment options especially in genotype 1 infected hepatitis C relapsers and nonresponders to interferon/ribavirin therapy. The aim of this study was to analyze the long-term treatment efficiency of telaprevir-based triple therapy for patients with hepatitis C reinfection after orthotopic liver transplantation. Patients and Methods. We included 12 patients with histologically confirmed graft fibrosis due to hepatitis C reinfection. The treatment duration was scheduled as 12 weeks of telaprevir-based antiviral triple therapy followed by 36 weeks of dual therapy with pegylated interferon/ribavirin. The patients were followed up for two years after the end of triple therapy. Results. Of the 12 patients, 6 (50%) completed the full 48 weeks of antiviral treatment. An end of treatment response and a sustained virological response 52 weeks after the end of the antiviral treatment course were achieved in 8/12 (67%) and 7/12 (58%) patients, respectively. Conclusion. Telaprevir-based triple therapy was shown to be a long-term effective but complex treatment option for individual patients with hepatitis C graft. With the recent improvements in hepatitis C therapy options telaprevir may not be recommended as a standard therapy for this indication anymore.
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46
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Song ATW, Sobesky R, Vinaixa C, Dumortier J, Radenne S, Durand F, Calmus Y, Rousseau G, Latournerie M, Feray C, Delvart V, Roche B, Haim-Boukobza S, Roque-Afonso AM, Castaing D, Abdala E, D’Albuquerque LAC, Duclos-Vallée JC, Berenguer M, Samuel D. Predictive factors for survival and score application in liver retransplantation for hepatitis C recurrence. World J Gastroenterol 2016; 22:4547-4558. [PMID: 27182164 PMCID: PMC4858636 DOI: 10.3748/wjg.v22.i18.4547] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Accepted: 01/18/2016] [Indexed: 02/06/2023] Open
Abstract
AIM: To identify risk factors associated with survival in patients retransplanted for hepatitis C virus (HCV) recurrence and to apply a survival score to this population.
METHODS: We retrospectively identified 108 patients retransplanted for HCV recurrence in eight European liver transplantation centers (seven in France, one in Spain). Data collection comprised clinical and laboratory variables, including virological and antiviral treatment data. We then analyzed the factors associated with survival in this population. A recently published score that predicts survival in retransplantation in patients with hepatitis C was applied. Because there are currently no uniform recommendations regarding selection of the best candidates for retransplantation in this setting, we also described the clinical characteristics of 164 patients not retransplanted, with F3, F4, or fibrosing cholestatic hepatitis (FCH) post-first graft presenting with hepatic decompensation.
RESULTS: Overall retransplantation patient survival rates were 55%, 47%, and 43% at 3, 5, and 10 years, respectively. Patients who were retransplanted for advanced cirrhosis had survival rates of 59%, 52%, and 49% at 3, 5, and 10 years, while those retransplanted for FCH had survival rates of 34%, 29%, and 11%, respectively. Under multivariate analysis, and adjusting for the center effect and the occurrence of FCH, factors associated with better survival after retransplantation were: negative HCV viremia before retransplantation, antiviral therapy after retransplantation, non-genotype 1, a Model for End-stage Liver Disease (MELD) score < 25 when replaced on the waiting list, and a retransplantation donor age < 60 years. Although the numbers were small, in the context of the new antivirals era, we showed that outcomes in patients who underwent retransplantation with undetectable HCV viremia did not depend on donor age and MELD score. The Andrés score was applied to 102 patients for whom all score variables were available, producing a mean score of 43.4 (SD = 6.6). Survival rates after the date of the first decompensation post-first liver transplantation (LT1) in the liver retransplantation (reLT) group (94 patients decompensated) at 3, 5, and 10 years were 62%, 59%, and 51%, respectively, among 78 retransplanted individuals with advanced cirrhosis, and 42%, 32%, and 16% among 16 retransplanted individuals with FCH. In the non-reLT group with hepatic decompensation, survival rates were 27%, 18%, and 9% at 3, 5, and 10 years, respectively (P < 0.0001). Compared with non-retransplanted patients, retransplanted patients were younger at LT1 (mean age 48 ± 8 years compared to 53 ± 9 years in the no reLT group, P < 0.0001), less likely to have human immunodeficiency virus (HIV) co-infection (4% vs 14% among no reLT patients, P = 0.005), more likely to have received corticosteroid bolus therapy after LT1 (25% in reLT vs 12% in the no reLT group, P = 0.01), and more likely to have presented with sustained virological response (SVR) after the first transplantation (20% in the reLT group vs 7% in the no reLT group, P = 0.028).
CONCLUSION: Antiviral therapy before and after retransplantation had a substantial impact on survival in the context of retransplantation for HCV recurrence, and with the new direct-acting antivirals now available, outcomes should be even better in the future.
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Crittenden NE, Buchanan LA, Pinkston CM, Cave B, Barve A, Marsano L, McClain CJ, Jones CM, Marvin MR, Davis EG, Kuns-Adkins CB, Gedaly R, Brock G, Shah MB, Rosenau J, Cave MC. Simeprevir and sofosbuvir with or without ribavirin to treat recurrent genotype 1 hepatitis C virus infection after orthotopic liver transplantation. Liver Transpl 2016; 22:635-43. [PMID: 26915588 DOI: 10.1002/lt.24422] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2015] [Revised: 02/15/2016] [Accepted: 02/20/2016] [Indexed: 12/14/2022]
Abstract
Although combination simeprevir (SIM) plus sofosbuvir (SOF) is an approved regimen for genotype 1 chronic hepatitis C virus (HCV), data regarding its safety and efficacy in liver transplant recipients remain limited. A multicenter retrospective study was performed to determine the efficacy and tolerability of a 12-week regimen of SIM/SOF with or without ribavirin (RBV) in 56 consecutive liver transplant recipients in 2014; 79% of patients had genotype 1a, 14% had cirrhosis, and 73% were treatment experienced. Sustained virological response at 12 weeks (SVR12) was 88% by intention to treat analysis (95% confidence interval, 84%-90%). Four patients relapsed, but no on-treatment virological failures occurred. The Q80K polymorphism did not impact SVR12, but there was a trend toward decreased sustained virological response with advanced fibrosis (P = 0.18). HCV RNA was detectable at treatment week 4 in 21% of patients, and those who had detectable levels were less likely to achieve SVR12 (58% versus 95%; P = 0.003). Five patients had baseline Child-Pugh class B cirrhosis, and 2 of them died (1 following early discontinuation of therapy). An additional discontinuation resulted from a severe photosensitivity reaction in a patient on concomitant cyclosporine. Seven patients receiving RBV developed progressive anemia requiring intervention. Immunosuppression dose modifications were minimal. SIM/SOF for 12 weeks was effective and well tolerated by compensated liver transplant recipients especially when administered without concomitant RBV or cyclosporine. SIM/SOF appears to have a niche as the only 12-week RBV-free treatment regimen currently recommended by guidelines for compensated transplant recipients. However, 12 weeks may not be the optimal duration of therapy for those with detectable virus at week 4 or possibly for those with cirrhosis. These data require confirmation by prospective randomized clinical trials. Liver Transplantation 22 635-643 2016 AASLD.
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Affiliation(s)
- Neil E Crittenden
- Departments of Medicine, Division of Gastroenterology, Hepatology, and Nutrition, University of Louisville, Louisville, KY
| | - Laura A Buchanan
- Departments of Medicine, Division of Digestive Health, University of Kentucky, Lexington, KY
| | - Christina M Pinkston
- School of Public Health and Information Sciences, University of Louisville, Louisville, KY
| | - Barbra Cave
- Departments of Medicine, Division of Gastroenterology, Hepatology, and Nutrition, University of Louisville, Louisville, KY.,KentuckyOne Health Transplant Center, Louisville, KY
| | - Ashutosh Barve
- Departments of Medicine, Division of Gastroenterology, Hepatology, and Nutrition, University of Louisville, Louisville, KY.,KentuckyOne Health Transplant Center, Louisville, KY.,Robley Rex Veterans Affairs Medical Center, Louisville, KY
| | - Luis Marsano
- Departments of Medicine, Division of Gastroenterology, Hepatology, and Nutrition, University of Louisville, Louisville, KY.,KentuckyOne Health Transplant Center, Louisville, KY.,Robley Rex Veterans Affairs Medical Center, Louisville, KY
| | - Craig James McClain
- Departments of Medicine, Division of Gastroenterology, Hepatology, and Nutrition, University of Louisville, Louisville, KY.,Pharmacology and Toxicology, University of Louisville, Louisville, KY.,KentuckyOne Health Transplant Center, Louisville, KY.,Robley Rex Veterans Affairs Medical Center, Louisville, KY
| | - Christopher M Jones
- Surgery, Division of Transplantation, University of Louisville, Louisville, KY.,KentuckyOne Health Transplant Center, Louisville, KY
| | - Michael R Marvin
- Surgery, Division of Transplantation, University of Louisville, Louisville, KY.,KentuckyOne Health Transplant Center, Louisville, KY
| | - Eric G Davis
- Surgery, Division of Transplantation, University of Louisville, Louisville, KY.,KentuckyOne Health Transplant Center, Louisville, KY
| | - Candice B Kuns-Adkins
- Departments of Medicine, Division of Digestive Health, University of Kentucky, Lexington, KY
| | - Roberto Gedaly
- Surgery, Division of Transplantation, University of Kentucky, Lexington, KY.,Healthcare Transplant Center, University of Kentucky, Lexington, KY
| | - Guy Brock
- School of Public Health and Information Sciences, University of Louisville, Louisville, KY
| | - Malay B Shah
- Surgery, Division of Transplantation, University of Kentucky, Lexington, KY.,Healthcare Transplant Center, University of Kentucky, Lexington, KY
| | - Jens Rosenau
- Departments of Medicine, Division of Digestive Health, University of Kentucky, Lexington, KY.,Healthcare Transplant Center, University of Kentucky, Lexington, KY
| | - Matthew C Cave
- Departments of Medicine, Division of Gastroenterology, Hepatology, and Nutrition, University of Louisville, Louisville, KY.,Pharmacology and Toxicology, University of Louisville, Louisville, KY.,Biochemistry and Molecular Genetics, University of Louisville, Louisville, KY.,KentuckyOne Health Transplant Center, Louisville, KY.,Robley Rex Veterans Affairs Medical Center, Louisville, KY
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48
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Ajlan A, Al-Jedai A, Elsiesy H, Alkortas D, Al-Hamoudi W, Alarieh R, Al-Sebayel M, Broering D, Aba Alkhail F. Sofosbuvir-Based Therapy for Genotype 4 HCV Recurrence Post-Liver Transplant Treatment-Experienced Patients. Can J Gastroenterol Hepatol 2016; 2016:2872371. [PMID: 27446833 PMCID: PMC4904700 DOI: 10.1155/2016/2872371] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Accepted: 11/10/2015] [Indexed: 12/20/2022] Open
Abstract
Background and Aim. This is an open label prospective cohort study conducted at a tertiary care hospital. The primary endpoint is SVR12 in patients treated with sofosbuvir-based therapy in post-liver transplant patients with genotype 4 HCV recurrence. Methodology. Thirty-six treatment-experienced liver transplant patients with HCV recurrence received sofosbuvir and ribavirin ± peginterferon. Results. We report here safety and efficacy data on 36 patients who completed the follow-up period. Mean age was 56 years, and the cohort included 24 males and one patient had cirrhosis. Mean baseline HCV RNA was 6.2 log10 IU/mL. The majority of patients had ≥ stage 2 fibrosis. Twenty-eight patients were treated with pegylated interferon plus ribavirin in addition to sofosbuvir for 12 weeks and the remaining were treated with sofosbuvir plus ribavirin only for 24 weeks. By week 4, only four (11.1%) patients had detectable HCV RNA. Of the 36 patients, 2 (5.5%) relapsed and one died (2.75%). Conclusion. Our results suggest that sofosbuvir + ribavirin ± pegylated interferon can be utilized successfully to treat liver transplant patients with HCV recurrence.
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Affiliation(s)
- A. Ajlan
- Pharmaceutical Care Division, King Faisal Specialist Hospital and Research Centre, MBC-11, P.O. Box 3354, Riyadh 11211, Saudi Arabia
| | - A. Al-Jedai
- Pharmaceutical Care Division, King Faisal Specialist Hospital and Research Centre, MBC-11, P.O. Box 3354, Riyadh 11211, Saudi Arabia
- Alfaisal University, College of Medicine, Riyadh, Saudi Arabia
| | - H. Elsiesy
- Alfaisal University, College of Medicine, Riyadh, Saudi Arabia
- Liver & Small Bowel Transplant and Hepatobiliary and Pancreatic Surgery-Organ Transplant Center, King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia
| | - D. Alkortas
- Pharmaceutical Care Division, King Faisal Specialist Hospital and Research Centre, MBC-11, P.O. Box 3354, Riyadh 11211, Saudi Arabia
| | - W. Al-Hamoudi
- Liver & Small Bowel Transplant and Hepatobiliary and Pancreatic Surgery-Organ Transplant Center, King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia
- King Saud University, College of Medicine, Riyadh, Saudi Arabia
| | - R. Alarieh
- Liver & Small Bowel Transplant and Hepatobiliary and Pancreatic Surgery-Organ Transplant Center, King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia
| | - M. Al-Sebayel
- Liver & Small Bowel Transplant and Hepatobiliary and Pancreatic Surgery-Organ Transplant Center, King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia
| | - D. Broering
- Liver & Small Bowel Transplant and Hepatobiliary and Pancreatic Surgery-Organ Transplant Center, King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia
| | - F. Aba Alkhail
- Alfaisal University, College of Medicine, Riyadh, Saudi Arabia
- Liver & Small Bowel Transplant and Hepatobiliary and Pancreatic Surgery-Organ Transplant Center, King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia
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49
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Abstract
BACKGROUND Hepatitis B virus (HBV)- and hepatitis C virus (HCV)-associated liver cirrhosis is a major indication for liver transplantation. This concise review gives an overview about current interferon (IFN)-free treatment options before and after liver transplantation in HBV- or HCV-associated liver disease. METHODS A PubMed database search using the terms hepatitis B, hepatitis C, cirrhosis, and liver transplantation was performed to identify significant clinical studies as well as national and international guidelines. RESULTS Studies investigating IFN-free treatment in patients with decompensated HBV as well as in HCV-associated cirrhosis are scarce. Hepatic recompensation during antiviral therapy seems more frequent in patients with HBV than in those with HCV-associated cirrhosis. Graft hepatitis B or C is characterized by an accelerated and unfavorable course. Graft infection prophylaxis is safe and efficacious in HBV-related liver transplantation. Eradication of HCV prior to liver transplantation prevents HCV graft infection, and IFN-free treatment of established HCV graft infection is safe and associated with high sustained virologic response rates. CONCLUSION Patients with HBV-associated cirrhosis should be treated prior to liver transplantation, and receive a continuing graft infection prophylaxis thereafter. Patients with HCV-associated decompensated cirrhosis may be considered as candidates for antiviral therapy prior to liver transplantation or may be treated subsequently.
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Affiliation(s)
- Martin-Walter Welker
- Medizinische Klinik 1, Universitätsklinikum Frankfurt, Frankfurt am Main, Germany
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50
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Welker MW, Luhne S, Lange CM, Vermehren J, Farnik H, Herrmann E, Welzel T, Zeuzem S, Sarrazin C. Lactic acidosis in patients with hepatitis C virus cirrhosis and combined ribavirin/sofosbuvir treatment. J Hepatol 2016; 64:790-9. [PMID: 26658684 DOI: 10.1016/j.jhep.2015.11.034] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2015] [Revised: 11/12/2015] [Accepted: 11/23/2015] [Indexed: 12/19/2022]
Abstract
BACKGROUND & AIMS Sofosbuvir (SOF) based interferon-alfa free antiviral therapy has become the treatment of choice for patients with chronic hepatitis C virus (HCV) infection. Little is known about safety of drug combinations using two nucleos(t)ide polymerase inhibitors in patients with HCV associated advanced cirrhosis. Here, we report frequent occurrence of lactic acidosis associated with acute-on-chronic hepatic decompensation during ribavirin (RBV) plus SOF based antiviral therapy. METHODS Thirty-five patients with chronic hepatitis C and advanced fibrosis, compensated cirrhosis, and decompensated cirrhosis without and after liver transplantation were treated with SOF based antiviral therapy with and without RBV. Adverse events including lactic acidosis (pH <7.35, lactate >20 mg/dl) were recorded 24 weeks before and during (mean ±SD, 18±11 weeks) antiviral therapy. Efficacy was determined by assessment of serum HCV RNA. RESULTS We observed severe adverse events in 15/35 (43%) patients before (24 weeks) and in 12/35 (34%) patients during antiviral therapy, the majority in association with acute-on-chronic hepatic decompensation. Lactic acidosis occurred in 5/35 (14%) patients during therapy, while no event of lactic acidosis was observed prior to therapy. Lactic acidosis was associated with hepatic decompensation including renal failure and infection, and was severe (pH <7.3) in two patients. CONCLUSIONS RBV in combination with SOF based antiviral therapy in patients with HCV associated advanced cirrhosis may be associated with the development of lactic acidosis. Impaired renal function, and higher MELD/Child-Pugh scores were identified as potential risk factors.
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Affiliation(s)
- Martin-Walter Welker
- Medizinische Klinik 1, Universitätsklinikum Frankfurt, Theodor-Stern-Kai 7, 60590 Frankfurt, Germany.
| | - Stefan Luhne
- Medizinische Klinik 1, Universitätsklinikum Frankfurt, Theodor-Stern-Kai 7, 60590 Frankfurt, Germany
| | - Christian M Lange
- Medizinische Klinik 1, Universitätsklinikum Frankfurt, Theodor-Stern-Kai 7, 60590 Frankfurt, Germany
| | - Johannes Vermehren
- Medizinische Klinik 1, Universitätsklinikum Frankfurt, Theodor-Stern-Kai 7, 60590 Frankfurt, Germany
| | - Harald Farnik
- Medizinische Klinik 1, Universitätsklinikum Frankfurt, Theodor-Stern-Kai 7, 60590 Frankfurt, Germany
| | - Eva Herrmann
- Institut für Biostatistik und Mathematische Modellierung, Goethe Universität Frankfurt, Theodor-Stern-Kai 7, 60590 Frankfurt, Germany
| | - Tania Welzel
- Medizinische Klinik 1, Universitätsklinikum Frankfurt, Theodor-Stern-Kai 7, 60590 Frankfurt, Germany
| | - Stefan Zeuzem
- Medizinische Klinik 1, Universitätsklinikum Frankfurt, Theodor-Stern-Kai 7, 60590 Frankfurt, Germany
| | - Christoph Sarrazin
- Medizinische Klinik 1, Universitätsklinikum Frankfurt, Theodor-Stern-Kai 7, 60590 Frankfurt, Germany
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