Page 84 - The Flying Publisher Guide to Hepatitis C Treatment

84 | Hepatitis C Treatment

achieved and 12 of 15 patients who were HCV RNA-negative
before LT remained HCV RNA-negative ≥6 months
postoperatively. The following predictors of response in these
studies were identified: non-1 genotype, CTP class A (genotype 1
only), ability to tolerate full dose and duration of treatment,
lower pretreatment VL, a VL decrease ≥2 log 10 at week 4 of
treatment (Alsatie 2007). Premature discontinuation of the
therapy due to side effects was reported in 13-30% and dose
reductions were more frequent.
On the basis of available data, prophylactic antiviral therapy in
this setting to prevent recurrent HCV infection post-LT has a
limited role and may be associated with serious AEs.
Pretransplant therapy, using a low-accelerating dose regimen, is
an important treatment strategy but is applicable to selected
patients only. Prophylactic antiviral therapy should not be
considered in those with high MELD score (≥20) or CTP class B or
C. It is to be noted that up to two-thirds of patients who become
HCV RNA–negative on treatment will be HCV-free post-
transplantation.

Pre-emptive antiviral therapy after LT

Preemptive antiviral therapy started within 2-6 weeks after
transplantation has the advantage of a relatively low VL and the
absence or minimal evidence of histologic recurrence, but is
limited by tolerability, particularly in patients with high MELD
scores pre-transplantation.
Rates of SVR vary from 5% to 39% (Terrault 2008). Better results
were reported in adult-to-adult right lobe live donor LT for HCC
and low MELD scores as well as in planned living donor LT cases
with splenectomy (Sugawara 2010). Dose reductions were
required, more frequently for RBV than interferon, and
treatment discontinuations were highly variable across the
studies, ranging from 0% to 57%.
Two small trials have evaluated the efficacy of PegIFN in this
setting, one of which noted that only 41% of screened transplant
recipients were eligible to begin therapy (Chalasani 2005).