J Korean Med Sci.  2015 Nov;30(11):1577-1583. 10.3346/jkms.2015.30.11.1577.

Response-Guided Therapy for Hepatitis C Virus Recurrence Based on Early Protocol Biopsy after Liver Transplantation

• Kim H
• Lee KW
• Yi NJ
• Lee HW
• Choi Y
• Suh SW
• Jeong J
• Suh KS

• KMID: 2351106
• DOI: http://doi.org/10.3346/jkms.2015.30.11.1577

Abstract

Hepatitis C virus (HCV) recurrence after liver transplantation (LT) is universal and progressive. Here, we report recent results of response-guided therapy for HCV recurrence based on early protocol biopsy after LT. We reviewed patients who underwent LT for HCV related liver disease between 2010 and 2012. Protocol biopsies were performed at 3, 6, and 12 months after LT in HCV recurrence (positive HCV-RNA). For any degree of fibrosis, > or = moderate inflammation on histology or HCV hepatitis accompanying with abnormal liver function, we treated with pegylated interferon and ribavirin. We adjusted treatment period according to individual response to treatment. Among 41 HCV related recipients, 25 (61.0%) who underwent protocol biopsies more than once were enrolled in this study. The mean follow-up time was 43.1 (range, 23-55) months after LT. Genotype 1 and 2 showed in 56.0% and 36.0% patients, respectively. Of the 25 patients, 20 (80.0%) started HCV treatment after LT. Rapid or early virological response was observed in 20 (100%) patients. Fifteen (75.0%) patients finished the treatment with end-of-treatment response. Sustained virological response (SVR) was in 11 (55.0%) patients, including 5 (41.7%) of 12 genotype 1 and 6 (75.0%) of 8 non-genotype 1 (P = 0.197). Only rapid or complete early virological response was a significant predictor for HCV treatment response after LT (100% in SVR group vs. 55.6% in non-SVR group, P = 0.026). Overall 3-yr survival rate was 100%. In conclusion, response-guided therapy for HCV recurrence based on early protocol biopsy after LT shows encouraging results.

Keyword

Hepatitis C; Recurrence; Liver Transplantation; Therapeutics; Biopsy

MeSH Terms

Adult
Aged
Antiviral Agents/*administration & dosage
Biopsy
Drug Monitoring/*methods
Female
Hepatitis C/etiology/*pathology/*prevention & control
Humans
Liver Transplantation/*adverse effects
Male
Middle Aged
Recurrence
Reproducibility of Results
Retrospective Studies
Sensitivity and Specificity
Treatment Outcome
Watchful Waiting/methods
Antiviral Agents

Figure

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  Fig. 1 Results of early protocol biopsies in hepatitis C virus related recipient after liver transplantation. HCV, hepatitis C virus; LT, liver transplantation.

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  Fig. 2 Outcome of response-guided therapy for hepatitis C virus. HCV, hepatitis C virus; Tx., treatment; RVR, rapid virological response; EVR, early virological response; ETR, end-of-treatment response; SVR, sustained virological response.

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