Achieving
Sustained Viral Response for Patients with Recurrent Hepatitis C after
Transplantation Is Key for Long-Term Outcomes
Researchers
from the University of Bari, Italy, concluded that treating patients
after transplantation with antiviral therapy creates a sustained viral
response (SVR) and protects them from liver-related deaths. The purpose
of this study was to determine the long-term clinical outcomes of
patients post-transplant who underwent antiviral therapy for recurrent
hepatitis C virus (HCV) infection of the liver graft.
The use
in clinical practice of antiviral therapy for HCV recurrence after
liver transplantation is still controversial. Some favor antiviral
therapy while data coming from meta-analysis of published studies
do not recommend treatment in view of the frequent adverse effects
and the lack of clinical benefit.
Maria Rendina, MD, on behalf of the AISF RECOLT-C Group, examined
the records from 12 liver transplant centers in Italy over a 20-year
period, and showed data on SVR and long-term clinical outcomes for
a large post-transplantation patient population.
SVR was achieved in 35 percent of the 448 patients whose records were
included in this study. Researchers noted that patients who achieved
SVR received grafts from younger donors, received longer treatment
duration and cumulative dose of interferon, and had a lower drop-out
rate and lower incidence of diabetes; however there were no differences
in immunosuppressive strategy for these patients.
Of the 134 patients who died since transplantation, 73 percent of
those deaths were HCV related -- and only one of those patients was
able to achieve SVR. After univariate and multivariate analysis to
correct for other variables, researchers demonstrated that patients
with recurrent HCV who were unable to achieve SVR were at a high risk
for liver-related deaths.
According to Dr. Rendina, "The results of the study are important
as these data could have an impact on patient care: HCV viral eradication
significantly protects patients from liver-related death and, therefore,
must be strongly pursued." When asked about the future of research
in this area, Dr Rendina said, "Data from the AISF RECOLT-C Group
provide a direction for further randomized clinical trials aimed at
exploring various treatment options as well as the efficacy of new
antivirals."
Investigator affiliations: Gastroenterology, University of Bari,
Bari, Italy; Niguarda Hospital, Milan, Italy; Liver Transplant Center,
University of Modena, Modena, Italy; Gastroenterology, Maggiore Hospital,
Milan, Italy; Gastroenterology, University of Udine, Udine, Italy;
Gastroenterology, Ospedali Riuniti, Bergamo, Italy; Liver transplant
Center, S. Orsola Malpighi-Hospital, Bologna, Italy; Gastroenterology,
University of Padua, Padova, Italy; San Camillo Spallanzani Hospital,
Rome, Italy; Sapienza University, Rome, Italy; Tor Vergata University,
Rome, Italy; Internal Medicine, Catholic University, Rome, Rome, Italy.
