Are viral or host factors predictive of response to interferon-ribavirin in transplant patients with hepatitis C?

Abstract

In Europe and the United States, hepatitis C virus (HCV)-related end-stage liver disease is the main indicator of the need for liver transplantation (LT). Recurrence of hepatitis C in the graft is universal after LT in HCV RNA-positive candidates, leading to lobular or chronic active hepatitis in most patients and to cholestatic hepatitis in a minority of them. Cirrhosis occurs in 20–30% of transplant recipients within 5–10 years of transplantation [1] and at least 10% of patients will require re-transplantation for hepatitis C graft failure. Following transplantation, a significant increase in viral load is observed as the HCV follows a more aggressive course in immunocompromised patients when compared to competent patients. As a result, patient and graft survival are lower in HCV-positive recipients than in HCV-negative recipients [2]. Antiviral therapy based on pegylated interferon (Peg-IFN) in combination with ribavirin (RBV) is primarily given when there is histological evidence of recurrent HCV disease. However, as in the non-transplant setting, its efficacy is lower in HCV genotype 1 infected patients. The reported sustained virological response (SVR) rate with Peg-IFN and RBV in genotype 1 patients ranges from 12% to 40% (mean 28.7%) and is lower than in non-transplant patients [3]. Factors potentially responsible for the reduced virological response to Peg-IFN and RBV therapy in the setting of LT are: prior non-response to (Peg) IFN and RBV before transplantation, high prevalence of genotype 1, immunosuppression, intolerance, and side effects of IFN or RBV. Tolerability is a major issue, with 70–80% of patients requiring dose reduction and 10–40% requiring drug discontinuation [3]. Most studies show improvements in biochemical and necroinflammatory activity in virological responders. Less consistent improvements in fibrosis scores have been reported, possibly due to the stage of fibrosis at the initiation of therapy, with more advanced stages being less reversible [4,5]. A survival benefit was also reported in virological responders [6,7]. Predictive factors associated with SVR are: initial viral kinetics and more specifically viral

DOI: 10.1016/j.jhep.2010.01.023

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Cite this paper

@article{Roche2010AreVO, title={Are viral or host factors predictive of response to interferon-ribavirin in transplant patients with hepatitis C?}, author={Bruno Roche and Didier Samuel}, journal={Journal of hepatology}, year={2010}, volume={52 5}, pages={630-2} }