Page 86 - The Flying Publisher Guide to Hepatitis C Treatment

86 | Hepatitis C Treatment

significantly slowed in patients treated for more than 6 months
(Walter 2009). Using long-term maintenance antiviral therapy
has recently been shown to increase the probability of
biochemical and histological responses, regardless of the timing
of the HCV recurrence (de Martin 2010).
Achievement of SVR in the setting of recurrent HCV following
LT has a major impact on long-term outcomes, including
improved graft and patient survival. Identifying patients with a
greater likelihood of achieving SVR is an important
consideration in the selection of potential treatment candidates
and is a key factor in developing strategies for optimizing
response to therapy.
Predictors of response to therapy identified in different studies
(Terrault 2008, Selzner 2009, Gonzalez 2010, Fukuhara 2010)
were
– Non-1 HCV genotype
– Absence of prior antiviral therapy
– Donor age
– Pretreatment necroinflammatory activity and fibrosis stage
– Concomitant cyclosporine use
– Course completion (the rule of 80/80/80, see chapter 1)
– Low pretreatment HCV RNA (<1 million IU/ml)
– IL28B polymorphism in recipient and donor tissues
– RVR or EVR – that hold the highest predictive values of SVR.
Undetectable VL at 24 weeks of therapy was also noted to
confer a high predictive value (92%) for SVR and prolonged
treatment protocol was suggested in these LT recipients.

Side effects and safety of PegIFN/RBV therapy
The clinical spectrum of AEs is similar to the non-transplant
setting (see chapter 1). Dose reductions are frequent and drug
discontinuation rates are higher than in nontransplant patients.
A major limitation of antiviral therapy is tolerability,
particularly with respect to the hematologic AEs of PegIFN/RBV.
In a recent Cochrane review, up to 87.5% of patients required a
dose reduction and up to 42.9% of patients stopped treatment