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Early antiviral therapy failed to improve SVR in HCV patients after liver transplantation
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Early antiviral treatment for recurrent hepatitis C virus after liver transplantation was safe but provided no increased sustained virological response compared with deferred therapy, according to study data.
Researchers in Spain conducted a retrospective study of 222 patients infected with hepatitis C virus (HCV) genotype 1 who underwent liver transplantation (LT) from 2001 to 2010. Primary outcomes were sustained virological response (SVR) rates and long-term survival compared between two subgroups.
Patients who received antiviral therapy (AVT) and met study inclusion (n=105) were categorized by time to therapy initiation, based upon liver histology. An early treatment group (n=60) received AVT in the acute phase of recurrent HCV infection (median start after LT, 3 months); the deferred group (n=45) was treated during established chronic HCV (median start, 18 months).
SVR was not significantly different between the early AVT group (23%) and the deferred treatment patients (36%), and both groups achieved similar early virologic response (48% vs. 67%) and rapid virologic response (12% vs. 11%) rates.
In follow-up at a median of 5.8 years, researchers observed that all-cause and liver-related mortality were similar. Twenty-six patients died in the early treatment group and 11 in the deferred group. They included 24 patients from hepatic failure and five from HCC recurrence.
Using multivariate analysis with a Cox regression model, mortality-related independent variables included inability to reach SVR (HR=10.3; 95% CI, 1.3-18.3), bilirubin levels greater than 2 mg/dL before therapy (HR=6.1; 95% CI, 2.8-13.7) and graft donors aged older than 60 years (HR=3.1; 95% CI, 1.4-6.7).
“Our results do not support the notion that antiviral therapy in the early phase of recurrence increases the risk of [liver] rejection,” the researchers wrote. “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.”
Disclosure: See the study for a full list of relevant financial disclosures.
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