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PROGRESSION AND TREATMENT OF RECURRENT HEPATITIS C AFTER LIVER TRANSPLANTATION IN PATIENTS CO-INFECTED WITH HIV.
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Reported by Jules Levin
Michael E de Vera and the liver transplant group from the University of Pittsburgh, Pittsburgh, PA reported the latest update on transplants in HIV/HCV co-infected patients.
Although liver transplantation in patients with HIV infection in the era of highly active antiretroviral therapy (HAART) has been successful, some have reported significant graft loss in patients with hepatitis C due to its aggressive recurrence post transplant.
Here we report the clinical outcomes of hepatitis C recurrence and treatment in 15 patients who underwent liver transplantation between March, 1997 to the present. Immunosuppression consisted of FK and steroids.
Three patients were excluded because of early deaths (<30 days) from sepsis (2 patients) or primary non-function. The 12 remaining patients had a mean follow-up of 22.1 months (1.4 - 57.3 months). Four patients have died, none from recurrent hepatitis C (hepatocellular carcinoma, chronic rejection, overwhelming fungal sepsis, and bacterial pneumonia). Two of these patients had biopsy-proven hepatitis C including 1 who developed cirrhosis despite interferon and ribavirin.
Of the 8 patients who are alive, 7 have biopsy-proven recurrent hepatitis C diagnosed at a mean time of 6.7 ± 2.4 months after their transplant. Four subjects are currently on treatment, three with Pegylated-interferon/ribavirin.
Biochemical response was 75% while virological response was 25%. Histologically, the only patient who cleared HCV still progressed to cirrhosis and 2 other patients had stable hepatitis activity indexes and staging. The remaining patient has not had a follow-up biopsy.
All 4 patients on treatment required erythropoeitin and/or G-CSF and 1 patient required suspension of peg-interferon because of hematologic side effects. All patients have CD4 counts >200 and undetectable HIV viral loads.
The authors concluded that liver transplantation in patients co-infected with HIV and HCV is a successful therapeutic option. We have not had any rapid or aggressive courses of recurrent hepatitis C leading to allograft failure. Out of the 15 transplant patients, 8 are alive and 7 had recurrent HCV requiring therapy.
Thus far, these patients have been able to tolerate treatment and they appear to have a similar short-term response as compared to HCV patients without HIV. It remains to be seen whether HIV and immunosuppression will significantly hasten HCV recurrence with longer follow-ups.
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