Brief Article
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World J Gastroenterol. Jun 7, 2013; 19(21): 3255-3262
Published online Jun 7, 2013. doi: 10.3748/wjg.v19.i21.3255
Treatment of hepatitis C in compensated cirrhotic patients is equally effective before and after liver transplantation
Francesca Romana Ponziani, Eleonora Brigida Annicchiarico, Massimo Siciliano, Francesca D’Aversa, Maurizio Pompili, Antonio Gasbarrini
Francesca Romana Ponziani, Eleonora Brigida Annicchiarico, Massimo Siciliano, Francesca D’Aversa, Maurizio Pompili, Antonio Gasbarrini, UOC Internal Medicine and Gastroenterology, Policlinico A Gemelli, Catholic University of Rome, 00168 Rome, Italy
Author contributions: Ponziani FR and D’Aversa F searched literature and wrote the article, Ponziani FR collected data; Annicchiarico BE, Siciliano M, Pompili M and Gasbarrini A revised the article.
Correspondence to: Francesca D’Aversa, MD, UOC Internal Medicine and Gastroenterology, Policlinico A Gemelli, Catholic University of Rome, largo A. Gemelli 8, 00168 Rome, Italy. francesca.dav@hotmail.it
Telephone: +39-328-8624920 Fax: +39-6-30157249
Received: January 21, 2013
Revised: March 29, 2013
Accepted: April 27, 2013
Published online: June 7, 2013
Abstract

AIM: To investigate differences in tolerability and response to treatment in compensated cirrhotic patients affected by hepatitis C virus (HCV) infection before and after liver transplantation.

METHODS: Forty-three HCV non-liver transplanted (LT) cirrhotics (mean age 55 ± 8 years, 65.1% male, Child-Pugh-A, genotype 1-4: 65.1%, 2-3: 34.9%) and 17 LT recipients with recurrent HCV-related cirrhosis (mean age 57 ± 9 years, 88.2% male, Child-Pugh-A, genotype 1-4: 76.5%, 2-3: 23.5%) were included in the analysis from retrospective series. All patients received recombinant or pegylated interferon plus ribavirin at a standard dose and duration. Adverse events were recorded and classified according to the Common Terminology Criteria for Adverse Events. The mean duration of follow-up was of 4.3 ± 1.8 years after the end of the treatment.

RESULTS: An early virological response (EVR) was achieved in 30/43 (69.8%) non-LT and in 8/17 (47.1%) LT cirrhotics, a sustained virological response (SVR) in 18/43 (41.9%) and 5/17 (29.4 %), respectively. No statistical difference was observed in EVR and SVR rates between the two groups. Among HCV non-LT cirrhotics, 6/43 (13.9%) discontinued the treatment prematurely, 11.6% of them receiving ≤ 80% of treatment; 8/17 (47%) LT cirrhotics withdrew the treatment, 35.2% of them receiving ≤ 80% of treatment. If compared with LT-ones (P = 0.015), an higher risk of treatment discontinuation could affect LT cirrhotics, who undergo more frequently ≤ 80% of treatment (P = 0.05). None of the non-LT cirrhotics died after the end of the treatment. With no regards to the achievement of SVR, LT cirrhotic patients showed a reduced survival in respect to non-LT ones (87% at 1 year, 76% at 3 and 5 years after the end of treatment).

CONCLUSION: HCV antiviral treatment is equally effective in compensated cirrhotics both before and after LT, which patients show a higher risk of premature treatment withdrawal and a reduced survival, independently of the achievement of SVR.

Keywords: Hepatitis C virus, Hepatitis C virus antiviral treatment, Liver cirrhosis, Liver transplantation, Sustained virological response, Efficacy, Safety

Core tip: In patients with hepatitis C virus compensated liver cirrhosis antiviral treatment should be considered in order to prevent short to mid-term complications. However, the results of treatment with pegylated interferon plus ribavirin are worse than in non-cirrhotic patients. Furthermore, in non-liver transplanted (LT) cirrhotics, a sustained virological response to antiviral treatment is associated to improved survival, while, at present, no data regarding LT cirrhotic is available in literature. The present study highlights that cirrhotic patients who undergo antiviral treatment after liver transplantation have a worse prognosis, compared to non-LT ones, independently of the achievement of sustained virological response.