Antiviral therapy increases the risk of bacterial infections in HCV-infected cirrhotic patients awaiting liver transplantation: A retrospective study.

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J Hepatol. 2008 Dec 29. [Epub ahead of print]

Antiviral therapy increases the risk of bacterial infections in HCV-infected

cirrhotic patients awaiting liver transplantation: A retrospective study.

Carrión JA, Martínez-Bauer E, Crespo G, Ramírez S, Pérez-Del-Pulgar S,

García-Valdecasas JC, Navasa M, Forns X.

Liver Unit, Institut de Malalties Digestives, Hospital Clinic, Ciberehd and

IDIBAPS, University of Barcelona, Villarroel 170, Barcelona 08036, Spain.

BACKGROUND/AIMS: Recurrence of hepatitis C after liver transplantation (LT) is

universal and may cause premature graft loss. We evaluated the efficacy and

safety of antiviral therapy in HCV-infected patients with decompensated

cirrhosis awaiting LT. METHODS: Fifty-one patients underwent treatment with

peginterferon-alfa-2a and ribavirin. A control group of 51 untreated individuals

awaiting LT were matched by age, Child-Pugh and MELD scores and time on the

waiting list. RESULTS: Case and control patients were comparable for all

relevant variables. Fifteen treated patients (29%) had undetectable HCV-RNA at

the time of transplantation and 10 (20%) achieved SVR. Early virological

response and non-1 genotype were the strongest predictors of viral clearance.

There was a higher incidence of bacterial infections in treated patients vs

controls, particularly in Child-Pugh B-C individuals (17 vs 3 episodes)

(log-rank=0.0016). Importantly, the incidence of spontaneous bacterial

peritonitis (SBP) in patients who were not receiving norfloxacin prophylaxis

(n=83) was significantly higher in the treated group than in controls

(log-rank=0.01). CONCLUSIONS: Our data demonstrate that antiviral treatment

prevents hepatitis C recurrence in 20% of HCV-infected patients. However,

treatment should be recommended with caution in individuals with poor liver

function who do not receive norfloxacin prophylaxis for SBP, since it increases

the risk of bacterial infections.

PMID: 19217183 [PubMed - as supplied by publisher]