Successful Continuation of HCV Treatment After Liver Transplantation
BACKGROUND: Guidelines recommend that patients with hepatitis C virus (HCV)-related liver disease be treated for HCV before liver transplant (LT) to eliminate the virus before surgery. However, the unpredictability of donor organ availability may limit treatment duration. Interruption of HCV treatment with resumption post-LT is 1 potential solution which has not been investigated widely.
METHODS: Patients from 5 clinical centers included in the large, national, noninterventional Hepa-C registry who started treatment with direct-acting antiviral agents while awaiting LT were identified retrospectively and followed up prospectively. Fifteen patients who had treatment interruptions around LT were identified.
RESULTS: The majority of patients (12/15) received interferon-free regimens, most commonly sofosbuvir + daclatasvir (8/12), for a total of 24 weeks (13/15). Treatment was discontinued temporarily for a median of 5 (range, 2-33) days. Fourteen patients completing 12 weeks of follow-up achieved a sustained virological response. One patient who died before week 12 posttreatment achieved a response at posttreatment week 4. Treatment was generally well tolerated. Serious adverse events were recorded in 2 of 15 patients (anaemia in 1 patient; pneumonia in 1 patient); all arose after LT.
CONCLUSIONS: Resumption of direct-acting antiviral agent therapy after a temporary interruption around LT was highly effective, achieving sustained virological response in all patients who completed 12 weeks of posttreatment follow-up. Treatment was generally well tolerated pretransplantation and posttransplantation, with a low rate of serious adverse events. Such a strategy may offer an important new approach to the treatment of patients awaiting LT which may be assessed in future studies.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2017 |
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| Erschienen: |
2017 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:101 |
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| Enthalten in: |
Transplantation - 101(2017), 5 vom: 01. Mai, Seite 1009-1012 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Fernández Carrillo, Carlos [VerfasserIn] |
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| Links: |
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| Anmerkungen: |
Date Completed 16.08.2017 Date Revised 24.01.2018 published: Print Citation Status MEDLINE |
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| doi: |
10.1097/TP.0000000000001596 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM266727026 |
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| 500 | |a published: Print | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a BACKGROUND: Guidelines recommend that patients with hepatitis C virus (HCV)-related liver disease be treated for HCV before liver transplant (LT) to eliminate the virus before surgery. However, the unpredictability of donor organ availability may limit treatment duration. Interruption of HCV treatment with resumption post-LT is 1 potential solution which has not been investigated widely | ||
| 520 | |a METHODS: Patients from 5 clinical centers included in the large, national, noninterventional Hepa-C registry who started treatment with direct-acting antiviral agents while awaiting LT were identified retrospectively and followed up prospectively. Fifteen patients who had treatment interruptions around LT were identified | ||
| 520 | |a RESULTS: The majority of patients (12/15) received interferon-free regimens, most commonly sofosbuvir + daclatasvir (8/12), for a total of 24 weeks (13/15). Treatment was discontinued temporarily for a median of 5 (range, 2-33) days. Fourteen patients completing 12 weeks of follow-up achieved a sustained virological response. One patient who died before week 12 posttreatment achieved a response at posttreatment week 4. Treatment was generally well tolerated. Serious adverse events were recorded in 2 of 15 patients (anaemia in 1 patient; pneumonia in 1 patient); all arose after LT | ||
| 520 | |a CONCLUSIONS: Resumption of direct-acting antiviral agent therapy after a temporary interruption around LT was highly effective, achieving sustained virological response in all patients who completed 12 weeks of posttreatment follow-up. Treatment was generally well tolerated pretransplantation and posttransplantation, with a low rate of serious adverse events. Such a strategy may offer an important new approach to the treatment of patients awaiting LT which may be assessed in future studies | ||
| 650 | 4 | |a Journal Article | |
| 650 | 7 | |a Antiviral Agents |2 NLM | |
| 700 | 1 | |a Crespo, Gonzalo |e verfasserin |4 aut | |
| 700 | 1 | |a de la Revilla, Juan |e verfasserin |4 aut | |
| 700 | 1 | |a Castells, Lluís |e verfasserin |4 aut | |
| 700 | 1 | |a Buti, Maria |e verfasserin |4 aut | |
| 700 | 1 | |a Montero, José Luis |e verfasserin |4 aut | |
| 700 | 1 | |a Fábrega, Emilio |e verfasserin |4 aut | |
| 700 | 1 | |a Fernández, Inmaculada |e verfasserin |4 aut | |
| 700 | 1 | |a Serrano-Millán, Cristina |e verfasserin |4 aut | |
| 700 | 1 | |a Hernández, Victoria |e verfasserin |4 aut | |
| 700 | 1 | |a Calleja, José Luis |e verfasserin |4 aut | |
| 700 | 1 | |a Londoño, María-Carlota |e verfasserin |4 aut | |
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