Worse recent efficacy of antiviral therapy in liver transplant recipients with recurrent hepatitis C: Impact of donor age and baseline cirrhosis

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http://www3.interscience.wiley.com/journal/122467241/abstract

Liver Transplantation

See Also:

Hepatology

Volume 15 Issue 7, Pages 738 - 746

Published Online: 26 Jun 2009

Original Articles

Worse recent efficacy of antiviral therapy in liver transplant recipients with

recurrent hepatitis C: Impact of donor age and baseline cirrhosis

Marina Berenguer 1 3 4 *, Aguilera 1 3, Martín Prieto 1 3, Cecilia

Ortiz 3, Rodríguez 1, Federica Gentili 1, Blas Risalde 3, Angel Rubin 1,

Raquel Cañada 3, Palau 1 3, - Rayón 2 3

1Hepatogastroenterology Service, Hospital Universitari La Fe, Valencia, Spain

2Pathology Service, Hospital Universitari La Fe, Valencia, Spain

3Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y

Digestivas, Spain

4Facultad de Medicina, Universidad de Valencia, Valencia, Spain

email: Marina Berenguer (mbhaym@...)

*Correspondence to Marina Berenguer, Servicio de Hepatogastroenterología,

Hospital Universitario La Fe, Avenida Campanar 21, 46009 Valencia, Spain

See Editorial on Page 677

Telephone: 34-96-3868792; FAX: 34-96-3987333

Funded by:

Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas

is funded by the Instituto de Salud III; Grant Number: PI-050981,

CB06/04/0065

Colegio de Médicos de Valencia

Abstract

We hypothesized that antiviral efficacy [sustained virologic response (SVR)] has

improved in recent years in the transplant setting. Our aim was to assess

whether the efficacy of pegylated interferon (PegIFN)-ribavirin (Rbv) has

improved over time. One hundred seven liver transplant patients [74% men, 55.5

years old (range: 37.5-69.5), 86% genotype 1a or 1b] were treated with

PegIFN-Rbv for 355 (16-623) days at 20.1 (1.7-132.6) months after

transplantation. Tacrolimus was used in 61%. Sixty-seven percent had baseline

F3-F4 (cirrhosis: 20.5%). Donor age was 49 (12-78) years. SVR was achieved in 39

(36.5%) patients, with worse results achieved in recent years (2001-2003: n =

27, 46.5%; 2004: n = 23, 43.5%; 2005: n = 21, 35%; 2006 to January 2007: n = 36,

24%; P = 0.043). Variables associated with SVR in the univariate analysis

included donor age, baseline viremia and cirrhosis, bilirubin levels, rapid

virologic response and early virologic response (EVR), premature discontinuation

of PegIFN or Rbv, and accumulated Rbv dose. In the multivariate analysis, the

variables in the model were EVR [odds ratio (OR): 0.08, 95% confidence interval

(CI): 0.016-0.414, P = 0.002] and donor age (OR: 1.039, 95% CI: 1.008-1.071, P =

0.01). Variables that had changed over time included donor age, baseline

viremia, disease severity (cirrhosis, baseline bilirubin, and leukocyte and

platelet counts), interval between transplantation and therapy, and use of

growth factors. In the multivariate analysis, variables independently changing

were donor age (OR: 1.041, 95% CI: 1.013-1.071, P = 0.004), duration from

transplantation to antiviral therapy (OR: 1.001, 95% CI: 1.000-1.001, P =

0.013), and baseline leukocyte count (OR: 1.000, 95% CI: 1.000-1.000, P =

0.034). In conclusion, the efficacy of antiviral therapy with PegIFN-Rbv has

worsened over time, at least in our center. The increase in donor age and

greater proportion of patients treated at advanced stages of disease are

potential causes. Liver Transpl 15:738-746, 2009. © 2009 AASLD.

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Received: 3 September 2008; Accepted: 16 November 2008

Digital Object Identifier (DOI)

10.1002/lt.21707