 |
|
|
| |
PREDICTORS OF VIROLOGIC RESPONSE IN COMBINATION THERAPY WITH INTERFERON (IFN)
ALFA 2B PLUS RIBAVIRIN OF RECURRENT HEPATITIS C AFTER LIVER TRANSPLANTATION
(LT)
|
| |
| |
B. Lavezzo*, 1 A. Franchello, 2 A. Smedile, 1 D. Cocchis, 2 E. David, 3
A. Barbui, 4 A. Ottobrelli, 1 M. Fadda, 5 A. Brunati, 2 M. Salizzoni, 2 M.
Rizzetto, 1
*Presenting Author
1Dept Of Gastroenterology, 2Dept Of Liver Transplant Surgery, 3Dept Of
Pathology Division, 4Dept Of Virology Division, 5Dept Of Clinical Nutrition
Service, Molinette Hospital, Turin, Italy
Background: combination treatment (CT) with IFN plus ribavirin is efficacious
in small group of patients (pts) with recurrent hepatitis C after LT.
Predictor factors of response are lacking. Aim: to evaluate pre-treatment
predictors of virologic response (negative HCV-RNA by PCR, Monitor Roche) at
end of treatment (ETVR) and at 6 months (mo) of follow-up (SVR) in pts
treated with CT for recurrent hepatitis C. Methods: we evaluated 108 pts,
mean age 53 yr (29-65), 77% males76% genotype 1, with recurrent hepatitis C
after LT, histology at baseline: 20 pts acute hepatitis, 88 pts chronic
hepatitis with mean grading score of 5/18 (4-11) and mean staging score 2/6
(1-5). They were treated with IFN alfa 2b 3 MU x 3 weekly plus ribavirin 800
mg/die for 6 or 12 mo. Median time LT to treatment was 10 mo (2-86)
Immunosuppressive therapy was cyclosporine in 63%, FK in 37% of pts. Mean ALT
levels pre-treatment was 238 UI/L (50-1000), mean HCV-RNA level 38 MEq/ml (0,
7-120). Age, gender, immunosuppression, baseline ALT and HCV-RNA levels,
histological grading and staging pre-treatment duration of therapy, time
interval from LT to start of therapy, genotype were evaluated by linear
multivariate regression analysis. Results: ETVR was obtained in 29, 6% of
pts, SVR in 23%. HCV genotype non-1 responded better than genotype 1 (SVR 46%
vs 16%, p: 0, 001). Age and baseline HCV-RNA were predictors of ETVR (p <
0.05), but not SVR (age p: 0, 07). Duration of therapy was correlated with
SVR, but virologic relapse occurred only in genotype-1 pts. In relapsed pts
serum HCV-RNA became negative just before the end of therapy. Conclusions: in
LT genotype non-1 is predictor of SVR. In genotype-1 duration of therapy
should be personalized to obtain a better and stable efficacy of treatment.
|
|
| |
|
|
|
|
|
