Outcome of early vs. Deferred antiviral treatment for recurrent hepatitis C in liver transplant recipients

Isabel Campos-Varela, Juan Ignacio Esteban, Marta Bes, Cristina Dopazo, Helena Allende, Francisco Rodríguez-Frías, María Teresa Salcedo, Silvia Sauleda, Ramón Charco, Jaime Guardia, Rafael Esteban, Lluis Castells

Research output: Contribution to journalArticleResearchpeer-review

Abstract

The optimal timing to treat recurrent hepatitis-C virus (HCV) after liver transplantation (LT) remains uncertain. We compared the outcome of early (acute phase) and deferred (chronic phase) antiviral treatment for recurrent HCV infection in this population. Consecutive HCV genotype-1 infected LT patients receiving antiviral therapy between 2001-2010 were retrospectively classified according to histology at treatment start into the early or deferred treatment group. Measured endpoints included sustained virological response (SVR) rates and long-term survival. The study cohort comprised 105 patients: 60 (57%) received early treatment (ET) and 45 (43%) deferred treatment (DT). The median interval from LT to antiviral start was 3 (1-9) and 18 months (11-74) in ET and DT respectively. The SVR rate was similar in both treatment groups (23% ET and 36% DT; p = 0.27). After a median follow-up of 5.8 years, all-cause and liver-related mortality were similar in both groups. Variables independently associated with mortality included pre-treatment bilirubin > 2 mg/dL (HR 6.1, 95%CI: 2.8-13.7; p < 0.001), donor age > 60 (HR 3.1, 95%CI: 1.4-6.7; p = 0.01), and failure to achieve SVR (HR 10.3, 95%CI: 1.3-18.3; p = 0.03). In conclusion, early treatment of recurrent HCV is safe, but does not lead to higher SVR rates. In HCV-infected LT recipients, elevated bilirubin, older donor age, and failure to achieve SVR are independently associated with increased mortality. © 2013 Annals of Hepatology. All rights reserved.
Original languageEnglish
Pages (from-to)219-230
JournalAnnals of Hepatology
Volume13
Issue number2
Publication statusPublished - 1 Mar 2014

Keywords

  • Antiviral treatment
  • Hepatitis C recurrence
  • IL28B
  • Liver transplant
  • Survival

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