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A Retrospective Study on Recurrence of
Hepatitis C Genotype IV in Living Donor
Liver Transplantation 4 Years Experience
Introduction
Mostafa I.,Abd El All M.,Refaee
R.,Safwat W.,Omar A.,Fayez A.,Meteni
M.,Abd El All A., Fathi M., Abd El Fatah
F., Dorry A., Monayeri M., Hamed H., Abd
El Wahab S.
Liver Transplantation Unit
Wady El Neel Hospital,
Cairo, Egypt
Introduction:
Hepatitis C virus (HCV)-induced
cirrhosis is the commonest indication
for liver transplantation, but HCV
recurrence is nearly universal and may
worsen patient / graft outcomes. The
frequency and severity of HCV recurrence
has apparently increased in recent
years, raising concern about a possible
role for newer immunosuppressant
regimens in this increasae. Though the
infection of the graft is universal ,the
treatment of patients with HCV
recurrence cannot be totally
evidence-based. Liver Transplantation
started four years ago in several
centers in Egypt (more than 200
patients), In Wadi El Neel Hospital,
Since October 2001; 92 patients
underwent Living Donor Liver
Transplantation 77 Adults 68 patients
with HCV and 15Children. Mortality rate
was : 25 patients (27%). Early Post
Operative Mortality (19 patients) was
20.6 %. Late Mortality (6 patients) was
6.5% and was due to; two patients from
sepsis 20 & 6 month post operative, one
patient from cerebral Hemorrhage 18
month post operative, one patient from
Recurrent HCC 12 month post operative,
one patient from Recurrent Cholestatic
HCV (Re-transplanted and Died) and one
patient from CMV infection 14 month post
operative (patient refused to be
treated). Post-operative complications
were classified as early (mostly
surgical complications) and late
complications in the form of; biliary
complications (leak or stenosis),
chronic rejection and recurrence of HCV.
Many factors has been included in the
recurrence of HCV as; donor’s age and
ischemia time, pre-transplant HCV viral
load, other factors as obesity,
hyperglycemia and alcohol intake.
Immunosuppressant Regimen; Over
immunosuppressant leads not only to an
increased risk of sepsis, malignancy,
and drug-specific complications, but
will also enhance viral replication. The
optimal immunosuppressant regime has not
been established but a heavy induction
regime and treatment for acute rejection
are associated with more viral
replication and more graft damage.
Cyclosporine (CsA) has been shown in
vitro to suppress HCV replication as
effectively as interferon alpha (IFN-alpha),
an effect that is separate from the
immunosuppressive activity of CsA. Data
from bone marrow patients and
non-transplant patient populations
confirm that CsA inhibits HCV
replication. This anti-HCV effect is not
seen with tacrolimus .
Aim of the Study:
Impact of tacrolimus versus cyclosporine
in hepatitis C virus-infected living
related liver transplant recipients on
recurrent hepatitis. This study was a
multi variant study concentrating on :
relations between HCV recurrence and age
of recipient , age of donor , Liver
graft size , HCV-RNA before
transplantation , HCV-RNA after
transplantation and Immunosuppressant
type.
Results:
Mean Recipient Age (
Recurrence Group : 48 years , Non
Recurrence Group : 46.5 years) , Mean
Donor Age (Recurrence Group: 31 years ,
Non Recurrence Group : 26.5 years) ,
Mean Donor Age (Recurrence Group : 31
years , Non Recurrence Group : 26.5
years) , Liver Graft size ( Recurrence
Group : 1.268 +/- 0.252 , Non Recurrence
Group : 1.085 +/- 0.21) , Mean HCV-RNA
before transplantation (Recurrence Group
: 271X103 +/- 107.812 , Non Recurrence
Group : 269X103 +/- 262.534) , Mean HCV-RNA
after transplantation ( Recurrence Group
: 969.818 x 103 +/- 636.002 , Non
Recurrence Group : 530.394 X 103 +/-
385.394 ) , Immunosuppressant type (
Recurrence Group :Neoral : 33 % ,
Tacrolimus : 67 % , Non Recurrence Group
: Neoral : 65 % , Tacrolimus : 35 % ).
All these multiple variants :Recipient
age ,donor age , HCV-RNA Before TX .
Relativity between donor and recipient
are not statistically significant
regarding HCV Recurrence. As regard
Immuno-Suppression, recurrence was more
with Tacrolimus but the difference was
not statistically significant regarding
HCV recurrence. HCV-RNA quantitative PCR
after TX is significantly higher in
recurrent group (Significant P<0.05).
While graft size is inversely
significant proportional to the
recurrence of Hep. C (Significant
P<0.05).
Conclusion:
In conclusion,
although that it is observed that the
recurrence is higher with tacrolimus;
the choice of calcineurin inhibitors
statistically does not impact severity
of recurrent HCV in this study. From
This Study we begin a randomized
prospective study (closed envelope) to
compare the relation between the use of
Tacrolimus or cyclosporin and the
recurrence of HCV (follow up for on
year).
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