Journal of Gastroenterology

, Volume 46, Issue 8, pp 1010–1019

A retrospective cohort study of partial splenic embolization for antiviral therapy in chronic hepatitis C with thrombocytopenia

  • Hiroki Tahara
  • Hitoshi Takagi
  • Ken Sato
  • Yasushi Shimada
  • Hiroki Tojima
  • Tomoyuki Hirokawa
  • Tatsuya Ohyama
  • Katsuhiko Horiuchi
  • Atsushi Naganuma
  • Hirotaka Arai
  • Satoru Kakizaki
  • Masatomo Mori
Original Article—Liver, Pancreas, and Biliary Tract

DOI: 10.1007/s00535-011-0407-9

Cite this article as:
Tahara, H., Takagi, H., Sato, K. et al. J Gastroenterol (2011) 46: 1010. doi:10.1007/s00535-011-0407-9

Abstract

Background

Although partial splenic embolization (PSE) is reportedly effective prior to interferon (IFN)-based therapy, the number of subjects in these studies is small, and the appropriate candidates and disease prognosis remain unknown.

Methods

PSE was performed in 30 patients with advanced hepatitis C who could not receive IFN-based therapy because of thrombocytopenia, platelet counts of ≤100,000/mm3, and hypersplenism. Also, we compared 25 PSE-treated patients with 23 PSE-untreated patients with thrombocytopenia receiving pegylated IFN (PEG-IFN)-alpha 2b plus ribavirin over the same period.

Results

PSE significantly increased platelet and leukocyte counts. PSE was well tolerated with no severe complications. All the patients could receive IFN-based therapy. Discontinuation of therapy in the total cohort of PSE-treated patients was not due to thrombocytopenia. Although PSE did not significantly increase the sustained virological response (SVR) rate, it significantly maintained higher platelet counts throughout the observation period and increased the percentage of patients with 100% adherence to PEG-IFN in the total controlled study population and in subjects with genotype 2. In PSE-treated patients with genotype 2, a trend towards increased SVR was noted. Four patients developed hepatocellular carcinoma (HCC) at a median of 14.5 months after PSE, even though two of these patients had achieved an SVR.

Conclusions

IFN-based therapy following PSE had an advantage in the maintenance of higher platelet counts, and PSE possibly caused an increase in adherence to PEG-IFN. Although patients with genotype 2 might be better candidates for PSE, further evaluation is needed. Careful follow-up of PSE-treated patients, even though they may have achieved an SVR, is needed to detect HCC.

Keywords

Partial splenic embolizationChronic hepatitis CInterferonRibavirinSustained virological responseThrombocytopenia

Abbreviations

CT

Computed tomography

HALT-C

Hepatitis C antiviral long-term treatment against cirrhosis

HCC

Hepatocellular carcinoma

HCV

Hepatitis C virus

IFN

Interferon

IL28B

Interleukin 28B

ISDR

IFN sensitivity-determining region

PEG-IFN

Pegylated IFN

PSE

Partial splenic embolization

rsp

Spearman rank correlation coefficient

SNPs

Single-nucleotide polymorphisms

SVR

Sustained virological response

Copyright information

© Springer 2011

Authors and Affiliations

  • Hiroki Tahara
    • 1
  • Hitoshi Takagi
    • 1
  • Ken Sato
    • 1
  • Yasushi Shimada
    • 1
  • Hiroki Tojima
    • 1
  • Tomoyuki Hirokawa
    • 1
  • Tatsuya Ohyama
    • 1
  • Katsuhiko Horiuchi
    • 1
  • Atsushi Naganuma
    • 1
  • Hirotaka Arai
    • 1
  • Satoru Kakizaki
    • 1
  • Masatomo Mori
    • 1
  1. 1.Department of Medicine and Molecular ScienceGunma University Graduate School of MedicineMaebashiJapan