Anemia is not predictive of sustained virological response in liver transplant recipients with hepatitis C virus who are treated with pegylated interferon and ribavirin

Authors

  • Michela Giusto,

    1. Liver Transplantation and Hepatology Unit, Research Center, La Fe Hospital, Valencia, Spain
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  • Maria Rodriguez,

    1. Liver Transplantation and Hepatology Unit, Research Center, La Fe Hospital, Valencia, Spain
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  • Laia Navarro,

    1. Liver Transplantation and Hepatology Unit, Research Center, La Fe Hospital, Valencia, Spain
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  • Angel Rubin,

    1. Liver Transplantation and Hepatology Unit, Research Center, La Fe Hospital, Valencia, Spain
    2. Ciberehd (Network Center for Biomedical Research in Hepatic and Digestive Diseases), Valencia, Spain
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  • Victoria Aguilera,

    1. Liver Transplantation and Hepatology Unit, Research Center, La Fe Hospital, Valencia, Spain
    2. Ciberehd (Network Center for Biomedical Research in Hepatic and Digestive Diseases), Valencia, Spain
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  • Fernando San-Juan,

    1. Liver Transplantation and Surgery Unit, Research Center, La Fe Hospital, Valencia, Spain
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  • Cecilia Ortiz,

    1. Experimental Immunity Unit, Research Center, La Fe Hospital, Valencia, Spain
    2. Ciberehd (Network Center for Biomedical Research in Hepatic and Digestive Diseases), Valencia, Spain
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  • Rafael López-Andujar,

    1. Liver Transplantation and Surgery Unit, Research Center, La Fe Hospital, Valencia, Spain
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  • Martín Prieto,

    1. Liver Transplantation and Hepatology Unit, Research Center, La Fe Hospital, Valencia, Spain
    2. Ciberehd (Network Center for Biomedical Research in Hepatic and Digestive Diseases), Valencia, Spain
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  • Marina Berenguer

    Corresponding author
    1. Liver Transplantation and Hepatology Unit, Research Center, La Fe Hospital, Valencia, Spain
    2. Ciberehd (Network Center for Biomedical Research in Hepatic and Digestive Diseases), Valencia, Spain
    3. Faculty of Medicine, University of Valencia, Valencia, Spain
    • Liver Transplantation and Hepatology Unit, La Fe Hospital, C/Bulevar sn, Valencia, Spain 46026. Telephone: +34 669869743; FAX: +34 961246257
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  • The Network Center for Biomedical Research in Hepatic and Digestive Diseases is funded by the Carlos III Institute of Health. Marina Berenguer is under the “Programa de intensificación de la actividad investigadora en el Sistema Nacional de Salud” funded by the Instituto de Salud Carlos III, and has received a grant (PI-050981) from the Instituto de Salud Carlos III.

Abstract

In the immunocompetent setting, antiviral therapy–related anemia has recently been shown to be associated with a sustained virological response (SVR). Our goal was to assess whether this is also true for liver transplantation (LT). We included 160 LT patients with recurrent hepatitis C virus (HCV) who were treated with pegylated interferon and ribavirin (RBV) between 2002 and 2010; 76% of the patients were men, the median age of the patients was 56 years (range = 33-75 years), 63% had advanced fibrosis, and 86% were infected with HCV genotype 1a or 1b. The baseline immunosuppression was tacrolimus in 56% of the patients. Mycophenolate mofetil (MMF) was used in 15%. Anemia was defined as a hemoglobin (Hb) level < 10 g/dL. Significant anemia was present when the Hb decline was >5 g/dL. Anemia and significant anemia developed in 67% and 41% of the patients, respectively. Erythropoietin was used in 60%. Factors independently associated with significant anemia included low estimated creatinine clearance [relative risk (RR) = 0.951, 95% confidence interval (CI) = 0.925-0.978, P = 0.0001], a longer time from LT to therapy (RR = 1.001, 95% CI = 1.000-1.001, P = 0.002), high baseline viremia (RR = 3.2, 95% CI = 1.3-8.1, P = 0.01), cyclosporine A (CSA)-based immunosuppression (RR: 3.472, 95% CI: 1.386-8.695; P = 0.008), and the use of MMF (RR: 5.346, 95% CI: 1.398-20.447; P = 0.014). An SVR occurred in 43% of the patients; the factors associated with an SVR included baseline variables (younger recipient age, younger donor age, infections with non-1 HCV genotypes, body mass index, and mild fibrosis) and on-treatment factors related to adherence or viral kinetics. Anemia resulted in RBV dose reductions but was not associated with the virological response at any time. In conclusion, anemia is a very frequent complication in LT patients during antiviral therapy and is associated with increased RBV dose reduction but not with an SVR. Predictors of anemia include MMF or CSA immunosuppression, high viremia, and renal insufficiency. Liver Transpl 17:1318–1327, 2011. © 2011 AASLD.

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