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ON TREATMENT VIROLOGICAL RESPONSE OF 70% IN 100 PATIENTS TREATED WITH COMBINATION ANTIVIRAL THERAPY FOR RECURRENT HCV FOLLOWING LIVER TRANSPLANTATION
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Reported by Jules Levin, NATAP
http://www.natap.org
from AASLD
San Francisco, Nov 11, 2005
Les Lilly, Nigel Girgrah, Abdul Al Alwan, Brenda McQuarrie, Philip Wong, Mark Cattral, Paul Greig, Ian McGilvray, Gary Levy, University Health Network, Toronto, Canada
Background: Chronic liver failure due to HCV infection is the leading indication for liver transplantation worldwide; disease recurrence after transplantation is inevitable. Short-term patient and graft survival following liver transplantation for hepatitis C are similar to other indications; long-term results are inferior. Response rates of recurrence to antiviral therapy are reported to be significantly lower than those seen in non-transplanted patients. A large single center experience is reported here.
Patients and Methods: 100 patients (73% Genotype 1) with histologically proven
recurrent HCV received at least three months of combination therapy with Interferon/PEG-Interferon and Ribavirin between Jan 98 and Jan 05. Serum aminotransferases, HCV-RNA and histology were followed.
Results:
Seventy patients (70%) achieved an on-treatment virological response (OTVR) at a mean of 5m on treatment; 65 of these have become HCV-RNA negative. 12/30 non-responders remain on treatment (mean 13m); therapy was discontinued in 18/30, 4 for side effects and 14 for lack of response to >12m of therapy; two of these patients died of decompensated cirrhosis. 49 patients have achieved an end of treatment response (ETR) following a mean of 15m of therapy; of the
remaining 21 OTVR pts, 20 remain on treatment while one has stopped due to adverse effects.
Of the 49 ETR patients, 24 have achieved an SVR, 7 have relapsed and 18 are 6m post treatment discontinuation. 61% of patients have required growth factors.
Rejection rate was 7%. Three patients who developed fibrosing cholestatic HCV within a year of tx are included, with 1 SVR, one OTVR still on treatment, and one non-responder who currently has decompensated cirrhosis 4y after transplant.
Conclusions: Combination therapy yields virological response in 70% of treated
patients, similar to that described in non-transplant patients; requirements
for growth factors are common. The optimal duration of therapy is unclear, although likely longer than in the nontransplant setting.
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