Predictors of sustained virological response after antiviral treatment for hepatitis C recurrence following liver transplantation

Authors

  • Matteo Cescon,

    1. General Surgery and Transplant Unit, Department of General Surgery and Transplantation, University of Bologna, Bologna, Italy
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  • Gian Luca Grazi,

    Corresponding author
    1. General Surgery and Transplant Unit, Department of General Surgery and Transplantation, University of Bologna, Bologna, Italy
    • Unità Operativa Chirurgia Generale e dei Trapianti, Padiglione 25, Policlinico Sant'Orsola-Malpighi, Via Massarenti 9, 40138, Bologna, Italy
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    • Telephone: +39-51-6364750; FAX: +39-51-304902

  • Alessandro Cucchetti,

    1. General Surgery and Transplant Unit, Department of General Surgery and Transplantation, University of Bologna, Bologna, Italy
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  • Gaetano Vetrone,

    1. General Surgery and Transplant Unit, Department of General Surgery and Transplantation, University of Bologna, Bologna, Italy
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  • Matteo Ravaioli,

    1. General Surgery and Transplant Unit, Department of General Surgery and Transplantation, University of Bologna, Bologna, Italy
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  • Giorgio Ercolani,

    1. General Surgery and Transplant Unit, Department of General Surgery and Transplantation, University of Bologna, Bologna, Italy
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  • Maria Cristina Morelli,

    1. General Surgery and Transplant Unit, Department of General Surgery and Transplantation, University of Bologna, Bologna, Italy
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  • Fabio Piscaglia,

    1. Department of Digestive Diseases and Internal Medicine, University of Bologna, Bologna, Italy
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  • Mariarosa Tamè,

    1. Department of Digestive Diseases and Internal Medicine, University of Bologna, Bologna, Italy
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  • Antonio Daniele Pinna

    1. General Surgery and Transplant Unit, Department of General Surgery and Transplantation, University of Bologna, Bologna, Italy
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Abstract

Factors associated with sustained virological response (SVR) in patients treated for hepatitis C virus (HCV) recurrence after liver transplantation (LT) are unclear. Ninety-nine HCV-positive/hepatitis B surface antigen–negative patients received antiviral treatment (AVT) with interferon/peginterferon plus ribavirin for HCV recurrence after LT. Cyclosporine (CyA) or tacrolimus (TAC) was used as the main immunosuppressor in 37 (37%) and 62 (63%) patients, respectively. Twenty-five patients (25%) achieved an SVR. Twenty-seven donor-related, recipient-related, HCV-related, and immunosuppression-related variables were investigated for their association with SVR. In logistic regression analysis, donor age < 60 years (odds ratio = 4.45, 95% confidence interval = 1.39-14.19, P = 0.01), viral genotype other than 1 (odds ratio = 4.97, 95% confidence interval = 1.59-15.48, P = 0.006), and the use of CyA during treatment (odds ratio = 6.85, 95% confidence interval = 2.15-21.73, P = 0.001) were predictors of SVR. Patients treated with CyA (SVR rate: 43%) and those treated with TAC (SVR rate: 14%) were comparable for all variables, except for a shorter ischemia time and shorter timing of AVT initiation in the TAC group (P = 0.02 and P = 0.005, respectively) and a greater use of anti-CD25 antibodies, azathioprine, and mycophenolate mofetil in the CyA group (P = 0.03, P < 0.001, and P = 0.001, respectively). The rate of AVT discontinuation due to side effects was similar between groups (16% versus 8%, P = 0.3). In conclusion, the type of immunosuppression during AVT may predict SVR in patients treated for HCV recurrence after LT. Liver Transpl 15:782–789, 2009. © 2009 AASLD.

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