Preemptive antiviral therapy started within 2-6 weeks after
transplantation has the advantage of a relatively low VL and the
absence or minimal evidence of histologic recurrence, but is
limited by tolerability, particularly in patients with high MELD
scores pre-transplantation.
Rates of SVR vary from 5% to 39% (Terrault 2008). Better results
were reported in adult-to-adult right lobe live donor LT for HCC
and low MELD scores as well as in planned living donor LT cases
with splenectomy (Sugawara 2010). Dose reductions were
required, more frequently for RBV than interferon, and
treatment discontinuations were highly variable across the
studies, ranging from 0% to 57%.
Two small trials have evaluated the efficacy of PegIFN in this
setting, one of which noted that only 41% of screened transplant
recipients were eligible to begin therapy (Chalasani 2005).
Management of recurrent HCV infection following liver transplantation | 85
Histological benefits in virologic nonresponders have been
demonstrated in a study where only 22% in a group receiving
preemptive therapy progressed vs. 49% of patients not receiving
preemptive therapy (Kuo 2008). However, this prophylactic
approach cannot be used in a considerable proportion of
patients due to initially intense immunosuppression,
pancytopenia, postoperative infections and insufficient recovery
after the surgery.
transplantation has the advantage of a relatively low VL and the
absence or minimal evidence of histologic recurrence, but is
limited by tolerability, particularly in patients with high MELD
scores pre-transplantation.
Rates of SVR vary from 5% to 39% (Terrault 2008). Better results
were reported in adult-to-adult right lobe live donor LT for HCC
and low MELD scores as well as in planned living donor LT cases
with splenectomy (Sugawara 2010). Dose reductions were
required, more frequently for RBV than interferon, and
treatment discontinuations were highly variable across the
studies, ranging from 0% to 57%.
Two small trials have evaluated the efficacy of PegIFN in this
setting, one of which noted that only 41% of screened transplant
recipients were eligible to begin therapy (Chalasani 2005).
Management of recurrent HCV infection following liver transplantation | 85
Histological benefits in virologic nonresponders have been
demonstrated in a study where only 22% in a group receiving
preemptive therapy progressed vs. 49% of patients not receiving
preemptive therapy (Kuo 2008). However, this prophylactic
approach cannot be used in a considerable proportion of
patients due to initially intense immunosuppression,
pancytopenia, postoperative infections and insufficient recovery
after the surgery.
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