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TREATMENT OF RECURRENT HCV INFECTION AFTER LIVER TRANSPLANTATION

TAJANA FILIPEC KANIŽAJ ; Merkur University Hospital, University of Zagreb, School of Medicine, Clinical Department of Internal Medicine, Zagreb, Croatia
VESNA ČOLIĆ-CVRLJE ; Merkur University Hospital, University of Zagreb, School of Medicine, Clinical Department of Internal Medicine, Zagreb, Croatia
ANNA MRZLJAK ; Merkur University Hospital, University of Zagreb, School of Medicine, Clinical Department of Internal Medicine, Zagreb, Croatia
RAJKO OSTOJIĆ ; Zagreb University Hospital Center, School of Medicine, University of Zagreb, Clinical Department of Internal Medicine, Department of Gastroenterology, Zagreb, Croatia

Abstract

Recurrent infection with HCV after liver transplantation (LT) is almost universal and is associated with substantial morbidity, mortality and graft loss. In contrast to immunocompetent individuals, HCV infection in immunosuppressed transplant recipients usually has an accelerated course. Acute hepatitis develops in approximately 75% of HCV recipients in the first six months following LT. Within the five years after LT, over 80% of HCV-infected liver transplant recipients develop histologic evidence of chronic allograft injury secondary to HCV, with up to 30% of cirrhosis. While the choice of calcineurin inhibitors has not clearly shown to affect the histologic HCV recurrence or the frequency of rejection in HCV-infected recipients, the cumulative exposure to corticosteroids is associated with increased mortality, higher levels of HCV viremia, and more severe histologic recurrence. Successful therapy has been shown to have a positive impact on both graft and patient survival. Combination therapy with interferon (pegylated and non-pegylated forms) plus ribavirin appears to provide maximum benefits. Drug therapy is usually administered for recurrent disease. No prophylactic therapy is available. Preemptive regimens offer no distinctive advantages over treatments for recurrent disease. Overall, treatment is poorly tolerated, with frequent need for dose reductions, especially due to cytopenias, and drug discontinuation in up to 50% of patients. Optimizing drug doses is important in maximizing sustained virologic response rates (SVR). The SVR achieved is between 33% and 42% in randomized studies treating patients with histologic recurrence. The potential factors that influence this low SVR rate are: 1) genotype 1 virus; 2) high viral load; 3) prior nonresponding to therapy; 4) side effects of antiviral treatment; 5) use of growth factors; and 6) effect of immunosuppression. In post-transplant patients with recurrent HCV disease, combination peg alpha-2b or alpha-2a in standard dose and ribavirin (800-1200 mg either ab initio or as an increasing dose) regimen for 48 weeks was significantly better than no therapy but not than any other therapy.

Keywords

HCV infection; liver transplantation; antiviral therapy

Hrčak ID:

113726

URI

https://hrcak.srce.hr/113726

Publication date:

14.1.2014.

Article data in other languages: croatian

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