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 24 February 2018

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News

Heavy initial immunosuppression can lead to HCV reinfection

The effects of different types of immunosuppression on the course of post-translational hepatitis C virus (HCV) infection has until now been unclear. However, a new study reported in the journal Transplantation has attempted to rectify this.

News image

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A research team from the Royal Free Hospital in London, England, evaluated the histological outcome of post-translational HCV infection with respect to initial immunosuppressive therapy.

Their study was carried out in a cohort of 59 HCV-positive patients who survived at least 12 months.

Within the study, 41 patients were administered initial triple immunosuppressive therapy involving cyclosporine or tacrolimus, as well as azathioprine and prednisolone.

5 patients received a double combination therapy of cyclosporine and prednisolone.

13 patients received either cyclosporine or tracrolimus only.

Assessment, by blinded histological evaluation, measured necroinflammatory activity (grading score: 0-18) and fibrosis (staging score: 0-6). The median histological follow-up was 36 months.

High necroinflammatory activity (grading score 4) - indicating chronic hepatitis - was identified in the final liver biopsies of 42 (71%) patients. Some 18 subjects (30.5%) were found to be suffering from severe fibrosis or cirrhosis (staging score 4).

There was a significant association between high necroinflammatory activity and absence of pre-transplant alcohol abuse, and also with occurrence of post-transplant acute lobular hepatitis C.

30% of HCV transplant patients develop fibrosis or cirrhosis.
Transplantation
Development of severe fibrosis or cirrhosis was significantly associated only with the type of initial immunosuppressive therapy.

In particular, severe fibrosis or cirrhosis developed more frequently in patients treated with triple or double (37%), than with single initial immunosuppressive therapy (8%), once adjustments had been made for biopsy time.

George V. Papatheodoridis, concluded on behalf of his fellow authors that, "Severe fibrosis or cirrhosis appears to develop in 30% of HCV transplant patients. This occurs in a median of 3 years and seems to be associated with heavier initial immunosuppression."

Transplantation 2001; 72 (3): 412-18
17 August 2001

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