Page 83 - The Flying Publisher Guide to Hepatitis C Treatment

Management of recurrent HCV infection following liver transplantation | 83

signal transducers and activators of transcription (STAT-1)
(Matsumoto 2009).

Prophylactic antiviral therapy in cirrhosis

The main goals of treating cirrhotic patients with antiviral
therapy are to prevent the complications of the disease, to halt
disease progression or allow for the regression of cirrhosis, and
to attain sustained viral clearance in order to prevent
reinfection in the graft in patients undergoing LT.
SVR in patients with Child-Pugh (CP) class A cirrhosis has
improved from 5% with interferon monotherapy to 50% with
pegylated interferon alfa (PegIFN) + ribavirin (RBV) in genotype
1 (Everson 2005).
The safety of combination therapy in cirrhotics is a major
concern. Bone marrow suppression by administration of either
standard or PegIFN alfa leads to significant decrease in all three
lineages of the hematopoietic system (Iacobellis 2008). However,
erythropoietic agents are effective in treating anemia,
preventing RBV dose reduction, improving patients‘ quality of
life, but the effect on SVR is not fully elucidated. Granulocyte
colony-stimulating factor is effective in raising ANC; however,
neutropenic HCV-infected patients on combination treatment
may not experience increased bacterial infections. Eltrombopag,
a new oral thrombopoietin mimetic, may allow combination
treatment in patients with cirrhosis and thrombocytopenia.
Antiviral therapy is commonly deferred in cirrhotics with signs
of liver decompensation, due to even more compelling concerns
over treatment-induced side effects (up to 60%).
There are several studies reporting experience with interferon-
based therapy in pre-transplant patients aiming to prevent
reinfection of the new graft (Alsatie 2007). The largest study
(Everson 2005) included 124 patients with an average CP score of
7.4 and a mean MELD (Model for End Stage Liver Disease – the
currently used allocation system, introduced in 2002 in USA in
order to prioritize patients on the waiting list) score of 11, who
received a low-accelerating-dose regimen. An SVR of 24% was