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Optimizing outcome of recurrent hepatitis C virus genotype 4 after living donor liver transplantation: moving forward
H M Dabbous1, M S Elmeteini1, M A Sakr1
1Ain Shams Center for Organ Transplant, Cairo, Egypt.
Insights
Early treatment of recurrent Hepatitis C Virus (HCV) genotype 4 after liver transplantation significantly improves outcomes. Protocol biopsies aid early detection, leading to better sustained virological response rates.
Area of Science:
- Hepatology
- Transplant Surgery
- Virology
Background:
- Recurrence of Hepatitis C Virus (HCV) after liver transplantation is common.
- Limited data exist on the outcomes of recurrent HCV genotype 4.
- Effective management strategies are needed to improve patient outcomes.
Purpose of the Study:
- To investigate the outcomes of treating recurrent HCV genotype 4 after living donor liver transplantation (LDLT).
- To identify factors influencing treatment response in this patient population.
- To optimize treatment protocols for recurrent HCV genotype 4 post-LDLT.
Main Methods:
- Retrospective chart review of 243 patients undergoing LDLT for HCV genotype 4.
- Protocol liver biopsies performed at six months post-transplant.
- Treatment with pegylated interferon and ribavirin for histological recurrence.
Main Results:
- Thirty-seven patients were included in the analysis.
- A sustained virological response (SVR) was achieved in 78.3% of patients.
- Higher SVR rates were observed in patients with earlier fibrosis stages (F0-F1).
Conclusions:
- Protocol biopsies enable early detection of graft inflammation before fibrosis progression.
- Prompt treatment of recurrent HCV genotype 4 post-LDLT leads to improved SVR rates.
- Early intervention is crucial for managing recurrent HCV genotype 4 after liver transplantation.
Purpose:
Recurrence of HCV after LDLT is almost universal. Different factors affect response to treatment. Few data are available regarding outcome of recurrent HCV genotype 4. The purpose of this study is to improve outcome of recurrent HCV genotype 4 after LDLT.
Methods:
An IRB approved chart review of 243 patients transplanted for ESLD, HCV genotype 4 over 4 years were reviewed. Protocol liver biopsies were taken 6 months after transplant. Patients received pegylated interferon and ribavirin in case of histological recurrence. Five patients had FCH were excluded.
Results:
Thirty-seven patients were included. Sustained Virological Response (SVR) was achieved in 29 (78.3%). Patients with Metavir fibrosis stage (F0) and (F1) had SVR in 5/5 (100%) and 20/24 (83.3%). Two patients with F1 had to stop treatment because of thrombocytopenia and 2 were non responders. Three out of 6 patients (50%) with (F2) had SVR, 2 were non responders and one had to discontinue treatment because of severe depression. One of 2 patients (50%) with F3 had SVR and the other patient decompensated within 4 months before treatment and died.
Conclusion:
Protocol biopsies allow early detection of inflammatory changes in the graft before fibrosis occurs. Early treatment of recurrent HCV genotype 4 after LDLT results in better response.
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