HIV and Hepatitis.com Coverage of the
42nd EASL Conference
April 11 - 15, 2007, Barcelona, Spain
THE EUROPEAN ASSOCIATION FOR THE STUDY OF THE LIVER

Response to PegIntron/ribavirin Leads to Stabilization of Fibrosis in Liver Transplant Recipients  

The most difficult problem facing liver transplant patients is recurrence of hepatitis C virus (HCV) infection. Due to poor tolerance of standard hepatitis C therapy and suboptimal outcomes, treatment for transplant recipients with recurrent HCV usually is restricted to those with significant fibrosis.

In the current study, reported at the 42nd Annual Meeting of the European Association for the Study of the Liver last month, researchers at the Hospital Clinic IDIBAPS in Barcelona, Spain, evaluated the effect of antiviral therapy on disease progression in 81 HCV-infected liver transplant recipients.

Patients with mild hepatitis C recurrence (fibrosis stage F0-F2; n=54) were randomized to receive either no treatment (Group A; n=27) or pegylated interferon alpha-2b (PegIntron) plus ribavirin for 48 weeks (Group B; n= 27). All patients with severe HCV recurrence (fibrosis stage F3-F4 or cholestatic hepatitis) received antiviral therapy (Group C; n=27). All 81 patients underwent liver biopsy at baseline and at the end of follow-up.

Results

  • Sustained virological response (SVR) rates were 48.0% in Group B and 18.5% in Group C.

  • Liver fibrosis progressed by 1 or more stages in 49% of the 81 patients with paired biopsies:
    • Group A (untreated): 70%;
    • Group B (treated, mild fibrosis): 26%;
    • Group C (treated, severe fibrosis):  54%.

  • Hepatic venous pressure gradient (HVPG) increased in patients with worsened fibrosis (6.5 to 13 mmHg), remained unchanged in those with fibrosis stabilization (6.5 mmHg), and decreased in those with fibrosis improvement (5 to 3.5 mmHg).

  • Treatment was the only variable independently associated with fibrosis stabilization or improvement.

  • Among treated patients, biochemical response (ALT normalization) and sustained virological response (SVR) were independently associated with liver fibrosis stabilization or improvement.

  • Similarly, early virological response (EVR) and SVR were predictors of hemodynamic response.

  • HVPG decreased in early virological responders (8 to 6 mmHg), but increased in patients who did not achieve EVR (6 to 13 mmHg); figures were similar for SVR.

Conclusion

Based on these results, the researchers concluded, “Our data demonstrate that in liver transplant recipients, HCV clearance during or after antiviral therapy slows disease progression, as shown by its effects on liver histology and on HVPG.”

They added that, “These results support a less restrictive indication [for] antiviral therapy in this population.”

05/01/07

Reference
J A Carrion, M Navasa, M Garcia-Retortillo, and others. Efficacy of Antiviral Therapy of Antiviral Therapy on Disease Progression in Hepatitis C Recurrence after Liver Transplantation: A Randomized Controlled Study. 42nd Annual Meeting of the European Association for the Study of the Liver. April 11-15, 2007. Barcelona, Spain.

 

 

 





























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