Partial splenic embolization and peg-IFN plus RBV in liver transplanted patients with hepatitis C recurrence: safety, efficacy and long-term outcome.

Published

Journal Article

There is limited information on the long-term outcome in liver transplant (LT) subjects undergoing partial splenic embolization (PSE) prior to full dose pegylated interferon/ribavirin (peg-IFN/RBV).Retrospective review of eight LT subjects after PSE and antiviral therapy.Baseline platelets and neutrophils were <50 000 cells/mL and <1000 cells/mL in 75% and 50%. Mean splenic infarction volume was 85 +/- 13%. PSE produced major complications in three (37.5%): recurrent sterile netrophilic ascites and renal insufficiency (n = 2), and splenic abscess (n = 1). Full-dose peg-IFN/RBV was started in seven (87.5%), with two early withdrawals (28.6%) despite early virological response (toxicity and infection); both subjects died. Anemia led to RBV dose-adjustment in six (86%), with human recombinant erythropoietin (EPO) use in four (57%). No peg-IFN adjustments or granulocyte-colonies stimulating factor were needed. Two patients reached sustained virological response (SVR) (28.6%). Two non-responders maintained prolonged therapy with biochemical/histological improvement. After a median follow-up of 151 wk, we observed significant improvements in hematological parameters, aspartate aminotransferase, alanine aminotransferase, international normalized ratio, and prothrombin activity.Extensive PSE after LT produced significant morbidity (37.5%). Peg-IFN/RBV was completed in five out of seven (71%), with SVR in two (28.6%). RBV adjustement due to anemia was high despite EPO use. Only patients able to complete or maintain antiviral therapy survived, with long-term significant benefits in hematological parameters and liver function tests.

Full Text

Cited Authors

  • Bárcena, R; Moreno, A; Foruny, JR; Blázquez, J; Graus, J; Riesco, JM; Blesa, C; García-Hoz, F; Sánchez, J; Gil-Grande, L; Nuño, J; Fortún, J; Rodriguez-Sagrado, MA; Moreno, A

Published Date

  • May 2010

Published In

Volume / Issue

  • 24 / 3

Start / End Page

  • 366 - 374

PubMed ID

  • 19863593

Pubmed Central ID

  • 19863593

Electronic International Standard Serial Number (EISSN)

  • 1399-0012

International Standard Serial Number (ISSN)

  • 0902-0063

Digital Object Identifier (DOI)

  • 10.1111/j.1399-0012.2009.01081.x

Language

  • eng