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High sustained virological response to pegylated interferon and ribavirin for recurrent genotype 3 hepatitis C infection post-liver transplantation

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Abstract

Introduction

Treatment outcomes of recurrent HCV genotype 3 (GT-3) after liver transplantation (LT) are ill-defined.

Aims

To determine efficacy, predictors, and long-term survival after treatment of recurrent HCV GT-3 infection, post-LT, with a combination of pegylated interferon (PEG) and ribavirin (RBV).

Methods

We studied all LT recipients (LTR) in our program treated with PEG and RBV for recurrent HCV GT-3 between Jan 1st 2002 and Dec 31st 2013. Antiviral therapy (AVT) was started if histology showed recurrent HCV with ≥stage2 fibrosis. Treatment was intended for 24 or 36 weeks, depending on early virologic response, and/or 24 weeks consolidation. Primary endpoint was sustained virological response (SVR). We also studied predictors of SVR and long-term patient survival.

Results

Among 492 LT for HCV-related cirrhosis and/or hepatocellular carcinoma performed during the study period, 110 (22 %) had HCV GT-3 infection. Fifty-two (10.5 %) HCV GT-3 patients had indications for AVT. Six were unable to complete the AVT, three because of clinical decompensation and one each because of metastatic disease involving the brain, lung cancer, and ductopenic rejection. Forty-seven (90 %) patients achieved early virological response (EVR) and 37 (71 %) achieved SVR. Predictors of SVR were EVR (p < 0.001), stage ≤3 fibrosis (p = 0.008), and 36 weeks treatment duration (p < 0.001). Less advanced fibrosis ≤3 was independent predictor of SVR (OR 0.18, 95 % CI 0.05–0.67). SVR patients had actuarial (Kaplan–Meier) 1, 3, and 10 year post-treatment survival of 100, 100, and 95 %, compared with 87, 78, and 20 % for non-SVR patients (p < 0.001, log rank test).

Conclusion

Efficacy of AVT for recurrent HCV GT-3 post-LT is high, and comparable with that for non-transplant patients. Less advanced fibrosis is an independent predictor of SVR. SVR improves long-term survival.

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Abbreviations

ACR:

Acute cellular rejection

AVT:

Antiviral therapy

CNI:

Calcineurin inhibitor

DDLT:

Deceased donor liver transplant

ETR:

End treatment response

EVR:

Early virological response

GCSF:

Granulocyte colony stimulating factor

GT:

Genotypes

HCC:

Hepatocellular carcinoma

HCV:

Hepatitis C virus

LDLT:

Living donor liver transplant

LT:

Liver transplant

NR:

Non-responders

PEG:

Pegylated interferon

RBV:

Ribavirin

RR:

Relapsers

RVR:

Rapid virological response

SD:

Standard deviation

SVR:

Sustained virological response

SVR 12:

Sustained virological response at 12 weeks

TGH:

Toronto General Hospital

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Compliance with ethical requirements and Conflict of interest

This study was approved by the Ethics Review Board of our hospital. The study was performed in compliance with all needed ethical requirements. Nabiha Faisal, Khalid Mumtaz, Max Marquez, Eberhard l. Renner and Leslie B. Lilly declare that they have no conflict of interest.

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Authors and Affiliations

  1. Liver Transplant Program/Multi-Organ Transplant Program, University Health, Network/Toronto General Hospital, University of Toronto, Toronto, ON, Canada

    Nabiha Faisal, Khalid Mumtaz, Max Marquez, Eberhard L. Renner & Leslie B. Lilly

  2. Gastroenterology, Hepatology and Nutrition Division, Ohio State University, Wexner Medical Center, 395 W 12th Avenue, Faculty Tower Building, Columbus, OH, USA

    Khalid Mumtaz

Authors
  1. Nabiha Faisal
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  2. Khalid Mumtaz
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Correspondence to Khalid Mumtaz.

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Faisal, N., Mumtaz, K., Marquez, M. et al. High sustained virological response to pegylated interferon and ribavirin for recurrent genotype 3 hepatitis C infection post-liver transplantation. Hepatol Int 9, 76–83 (2015). https://doi.org/10.1007/s12072-014-9589-6

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  • DOI: https://doi.org/10.1007/s12072-014-9589-6

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