Increased Duration of Dual Pegylated Interferon and Ribavirin Therapy for Genotype 1 Hepatitis C Post-Liver Transplantation Increases Sustained Virologic Response: A Retrospective Review
Department of Gastroenterology and Hepatology, Western University, London, ON, Canada
General Division, The Scarborough Hospital, Scarborough, ON, Canada
University of Alberta, Edmonton, AB, Canada
Meeting: 2013 American Transplant Congress
Abstract number: B1069
Aims: Hepatitis C–related cirrhosis is the leading indication for liver transplantation. HCV recurrence is almost universal, leading to advanced fibrosis in at least 30% of patients within 5 years of transplant. In patients with advanced post-transplant HCV recurrence, antiviral treatment with interferon and ribavirin is indicated, even though sustained virological response (SVR) is achieved in only 30% of patients. Aims were to determine and report Canadian data with respect to the safety, efficacy and SVR predictors of AVT among transplanted patients with HCV recurrence
Methods: A retrospective chart review was performed on patients transplanted in London, Ontario and Edmonton, Alberta from 2002-2012 and who were treated for Hepatitis C Virus (HCV).
Results: 85 patients (46 from London and 39 from Edmonton) with HCV received pegylated interferon with ribavirin post-liver transplant. 28/65 patients (43%) with genotype 1 achieved SVR. Of the patients having genotype 1 HCV who achieved SVR, there was a significantly lower stage of fibrosis (1.37±0.88 vs. 1.89±0.96; p=0.03), increased ribavirin dose (total daily dose 1057±230 vs. 856±399mg; p=0.02), increased Rapid Virologic Response (RVR; 6/27 vs. 0/31; p=0.05), increased Early Virologic Response (EVR: 28/28 vs. 18/35; p=0.006) and longer duration of therapy (54.7±13.4 weeks vs. 40.2±18.7; p=0.001). Logistic regression using gender, age, RVR, EVR, anemia, duration of therapy, viral load, years post-transplant, and type of organ (Donation after Cardiac Death vs. Donation after Brain Death) to predict SVR was significant (p<0.001). With multi-logistic regression, the duration of therapy had the only significant OR, with it being 1.078 (ie. for every extra week of therapy SVR increased 1.078 times; p=0.007).
Conclusions: HCV-positive patients who received dual therapy post-transplantation and achieved SVR had significantly lower stages of fibrosis, higher ribavirin doses, were more likely to have RVR and EVR, and had a longer duration of therapy. Logistic regression identified duration of therapy to be the main effect behind a predictive model of SVR in this cohort of post-transplant HCV patients.
Bain, V.: Other, Merck, Advisory Board, Vertex, Advisory Board.
To cite this abstract in AMA style:
Wells M, Marotta P, Levstik M, Chandok N, Roth L, Bain V, Mason A, Aljudaibi B. Increased Duration of Dual Pegylated Interferon and Ribavirin Therapy for Genotype 1 Hepatitis C Post-Liver Transplantation Increases Sustained Virologic Response: A Retrospective Review [abstract]. Am J Transplant. 2013; 13 (suppl 5). https://atcmeetingabstracts.com/abstract/increased-duration-of-dual-pegylated-interferon-and-ribavirin-therapy-for-genotype-1-hepatitis-c-post-liver-transplantation-increases-sustained-virologic-response-a-retrospective-review/. Accessed November 23, 2024.« Back to 2013 American Transplant Congress