In Hepatitis C virus-infected patients, it is generally assumed that the pattern of response to antiviral therapy remains unaltered after liver transplantation.
However, changes in the circulating Hepatitis C quasispecies and in the gene expression profiles of the graft might influence response to treatment after liver transplant.
Dr Xavier Forns and colleagues from Spain evaluated 22 Hepatitis C-infected patients who received antiviral treatment while awaiting liver transplant.
These patients had Hepatitis C infection recurrence, and 11 underwent a new antiviral treatment course.
The investigative team analyzed the early virological response to both treatment courses.
The investigators assessed the influence of the changes in Hepatitis C on the response to therapy.
Patients were considered early virological responders if viral load declined 2log10 or more during the first 12 weeks of therapy.
|Sensitivity changes to therapy after transplantation are not only dependent on Hep C strain variants|
|Journal of Viral Hepatitis|
The investigators considered the remaining individuals as nonresponders.
Hepatitis C sequences from hypervariable region 1 and nonstructural 5A (NS5A) region before both treatment regimens were compared.
Of 11 patients, 8 showed identical early response to both courses of therapy, and were included in Group A.
The team noted that of this group, 5 were early virological responders and 3 were nonresponders.
Interestingly, the investigators found that response changed in the remaining 3 patients reported as Group B.
Of these, 2 nonresponders became early virological responders after transplantation, whereas 1 early virological responder became a nonresponder.
Fixation of mutations within the NS5A occurred preferentially in Group B as compared with Group A.
However, the investigators observed that the number of fixed mutations was not significantly different between groups.
This suggests that the changes in sensitivity to therapy after liver transplantation are not exclusively dependent on variations in Hepatitis C strains.
Dr Forns' team concludes, “In Hepatitis C-infected patients undergoing liver transplantation, the pattern of response to antiviral treatment may change after transplantation, and this possibility needs to be incorporated in clinical practice.”