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Titolo:
Treatment of progressive hepatitis C recurrence after liver transplantation with combination interferon plus ribavirin
Autore:
Gopal, DV; Rabkin, JM; Berk, BS; Corless, CL; Chou, SW; Olyaei, A; Orloff, SL; Rosen, HR;
Indirizzi:
Oregon Hlth Sci Univ, Div Gastroenterol & Hepatol, Portland, OR 97201 USA Oregon Hlth Sci Univ Portland OR USA 97201 epatol, Portland, OR 97201 USA Oregon Hlth Sci Univ, Div Infect Dis, Portland, OR 97201 USA Oregon Hlth Sci Univ Portland OR USA 97201 ct Dis, Portland, OR 97201 USA Oregon Hlth Sci Univ, Dept Surg & Liver Transplantat, Portland, OR 97201 USA Oregon Hlth Sci Univ Portland OR USA 97201 lantat, Portland, OR 97201 USA Oregon Hlth Sci Univ, Dept Pathol, Portland, OR 97201 USA Oregon Hlth Sci Univ Portland OR USA 97201 Pathol, Portland, OR 97201 USA Portland Vet Affairs Med Ctr, Portland, OR 97201 USA Portland Vet Affairs Med Ctr Portland OR USA 97201 Portland, OR 97201 USA
Titolo Testata:
LIVER TRANSPLANTATION
fascicolo: 3, volume: 7, anno: 2001,
pagine: 181 - 190
SICI:
1527-6465(200103)7:3<181:TOPHCR>2.0.ZU;2-O
Fonte:
ISI
Lingua:
ENG
Soggetto:
COLONY-STIMULATING FACTOR; VIRAL-HEPATITIS; VIRUS-INFECTION; THERAPY; RECIPIENTS; ALPHA; PROPHYLAXIS; EFFICACY; TRIAL;
Tipo documento:
Article
Natura:
Periodico
Settore Disciplinare:
Clinical Medicine
Citazioni:
38
Recensione:
Indirizzi per estratti:
Indirizzo: Rosen, HR Oregon Hlth Sci Univ, Div Gastroenterol & Hepatol, 3710 SW US Vet Hosp Rd,POB 1034,P3-GI, Portland, OR 97201 USA Oregon Hlth Sci Univ 3710 SW US Vet Hosp Rd,POB 1034,P3-GI Portland OR USA 97201
Citazione:
D.V. Gopal et al., "Treatment of progressive hepatitis C recurrence after liver transplantation with combination interferon plus ribavirin", LIVER TRANS, 7(3), 2001, pp. 181-190

Abstract

Hepatitis C virus (HCV) recurrence after orthotopic liver transplantation (OLT) is common, although the majority of cases are mild. A subset of transplant recipients develops progressive allograft injury, including cirrhosisand allograft failure. Minimal data are available on the safety and efficacy of antiviral treatment in this group of patients. The aim of this study is to review our experience in the treatment of moderate to severe HCV recurrence with combination interferon-alpha 2b and ribavirin (IFN/RIB), Between October 1993 and October 1999, a total of 197 patients underwent OLT for HCV-related liver failure. This study describes 12 transplant recipients with moderate to severe recurrence treated with IFN/RIB, All patients met at least 1 of the following inclusion criteria: (1) moderate to severe inflammation (grade III to TV) on allograft biopsy, (2) bridging fibrosis on allograft biopsy, or (3) severe cholestasis attributable solely to HCV recurrence. Two patients had undergone re-OLT for allograft cirrhosis secondary to HCV recurrence and now had evidence of progressive HCV in their second allografts. Appropriate dose reductions of both IFN and RIB, as well as initiation of granulocyte colony-stimulating factor (G-CSF), for marked leukopenia were recorded. IFN/RIB therapy was started GO to 647 days post-OLT, and duration of therapy ranged from 39 to 515 days. Seven patients were administered G-CSF to successfully treat leukopenia. Six of the 12 patients (50%) became HCV RNA negative by polymerase chain reaction. One of these 6 patients (no. 1) was HCV RNA negative at 6 months but chose to discontinue therapy because of intolerable side effects, experienced a relapse, and was HCV RNA positive at 12 months. Two of the remaining 5 patients were HCV RNA negative at 2 and 3 months off therapy. For the entire group, there was a statistically significant decrease in serum biochemical indices assessed at initiation of therapy and 1, 3, and 6 months into therapy. Most patients required dose reductions of both IFN and RIB. Five patients died; 3 patients died ofliver-related complications that included severe intrahepatic biliary cholestasis, severe HCV recurrence, and chronic rejection with profound cholestasis. In the subset of HCV-positive liver transplant recipients with moderate to severe recurrence, combination IFN/RIB therapy resulted in complete virological response (serum RNA negative) in 6 of 12 patients (similar to 50%). However, only 1 of 12 patients (8.3%) had sustained virological clearance after cessation of IFN/RIB therapy. Dose reductions of both IFN and RIB were required in most patients. The use of G-CSF (sometimes preemptively) allowed correction of leukopenia and full-dose antiviral therapy. Multicenter trials using combination therapy to identify factors predictive of response are needed in the subset of patients with progressive allograft injury.

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Documento generato il 26/01/20 alle ore 01:10:46