Cyclosporine a-based immunosuppression reduces relapse rate after antiviral therapy in transplanted patients with hepatitis C virus infection: a large multicenter cohort study

• Published in: Transplantation Vol. 92; no. 3; p. 334
• Format: Journal Article
• Language: English
• Published: United States 15.08.2011
• Subjects: Antiviral Agents - administration & dosage; Antiviral Agents - adverse effects; Cohort Studies; Cyclosporine - administration & dosage; Female; Graft Rejection - drug therapy; Graft Rejection - epidemiology; Hepatitis C, Chronic - drug therapy; Hepatitis C, Chronic - epidemiology; Hepatitis C, Chronic - prevention & control; Humans; Immunosuppressive Agents - administration & dosage; Interferon-alpha - administration & dosage; Interferon-alpha - adverse effects; Liver Transplantation - statistics & numerical data; Logistic Models; Male; Middle Aged; Multivariate Analysis; Polyethylene Glycols - administration & dosage; Polyethylene Glycols - adverse effects; Postoperative Complications - drug therapy; Postoperative Complications - epidemiology; Postoperative Complications - prevention & control; Recombinant Proteins; Retrospective Studies; Ribavirin - administration & dosage; Ribavirin - adverse effects; Risk Factors; Secondary Prevention
• ISSN: 1534-6080
• DOI: 10.1097/TP.0b013e318223d836

The influence of immunosuppression on the response to antiviral treatment in recurrent hepatitis C is still under debate. The purpose of this study was to identify those factors that might predict sustained viral response and relapse. The ReViS-TC, a multicenter cohort study conducted in 14 Spanish liver centers, included data from liver transplant recipients from January 2000 to December 2006 who had recurrent hepatitis C virus and who had undergone antiviral treatment with pegylated interferon plus ribavirin. Sustained virological response (SVR) and viral relapse were evaluated. A multivariate logistic regression model was used to investigate host, donor, and therapeutic factors associated with SVR and relapse. The analysis included 410 patients, 30% treated with cyclosporine A (CsA) and 70% with tacrolimus. SVR was achieved in 48% of patients with CsA and in 37% with tacrolimus (P=0.037), with a relapse rate of 18% and 36%, respectively (P=0.008). In the multivariate model, the administration of CsA (odds ratio [OR] 0.37, P=0.021) in conjunction with a longer antiviral treatment duration (OR 0.86, P=0.024) correlated with lower relapse rate, whereas the older age of the donor (OR 1.03, P=0.006) and the presence of genotype 1 (OR 3.45, P=0.032) were associated with a higher probability of relapse. Our results suggest that the use of CsA-based immunosuppression regimens and longer treatment duration may protect patients against viral relapse after a positive response to pegylated interferon plus ribavirin therapy. These data need to be further confirmed in clinical trials.