Researchers from Nagoya, Japan, examined the long-term effects of phlebotomy on biochemical and histologic parameters of chronic hepatitis C.
There is considerable evidence that iron is a risk factor for liver injury in chronic hepatitis C.
Known as iron reduction therapy, phlebotomy reduces serum ALT activity. This effect might continue with maintenance phlebotomy and result in slower progression of liver fibrosis.
For the biochemical evaluation, 25 patients were treated by initial phlebotomy to reduce serum ferritin levels to 10 ng/ml or less. They were then observed for 5 years with maintenance phlebotomy, to maintain the iron-deficient state.
For histologic evaluation, liver biopsies were performed before and after the study period in 13 of the patients.
|Effect of phlebotomy:|
- Lowers serum aminotransferase
- Improves liver inflammation
- Slows liver fibrosis progression
| American Journal of Gastroenterology |
Thirteen patients, who were virologic nonresponders to interferon alone and had undergone second liver biopsies after more than 3 years, served as histologic controls.
The team found that serum aminotransferase levels were decreased significantly by initial phlebotomy and remained at the same levels during the study period.
The grading scores were improved significantly in the study group and unchanged in the controls.
It was found that the staging scores remained unchanged in the study group but were increased in the controls.
Disease progression was significantly different between the two groups.
Author M. Yano, of the Nagoya University School of Medicine, concluded on behalf of the group, "These results suggest that phlebotomy with maintenance lowers serum aminotransferase levels, improves liver inflammation, and suppresses the progression of liver fibrosis in chronic hepatitis C."
In an accompanying Editorial, Herbert L. Bonkovsky, of the University of Massachusetts Medical School, Worcester, Massachusetts, USA, comments that the study by Yano et al. provides evidence that long-term iron reduction may be of benefit to chronic hepatitis C patients.
He states that, "These important results need confirmation in prospective, randomized trials involving larger numbers of patients."
"Nevertheless, they are supportive of earlier results from Japan and several other countries, and consistent with emerging notions of iron as a comorbid factor adversely influencing nonhemochromatotic liver disease," he concludes.