THE PROBLEM OF VIRAL HEPATITIS IN LIVER TRANSPLANTATION

S. Asthana¹, K. Burak², V. Bain³, G. Meeberg¹, D. Bigam⁴, A.M..J. Shapiro⁵, N.M. Kneteman^6
1Transplant Surgery, University of Alberta Hospital, Edmonton/CANADA, ²Department Of Hepatology, University of Calgary, Calgary/CANADA, ³Hepatology, University of Alberta Hospital, Edmonton/AB/CANADA, ⁴Department Of Surgery, University of Alberta, Edmonton/CANADA, ⁵Surgery, University of Alberta, Edmonton/AB/CANADA, ⁶Department Of Surgery, University of Alberta, Edmonton/AB/CANADA

Body: Introduction: Hepatitis C-associated liver failure is the commonest indication for liver transplantation, and virological recurrence occurs universally. Antiviral therapy in recurrent HCV infection post-LT has a lower rate of sustained virologic response (SVR) compared to non-transplanted patients, reported at around 35%. This study assesses the impact of sirolimus (SRL) immunosuppression (IS) on the response to anti-HCV therapy in post-LT patients. Patients and Methods: All adult patients undergoing a first LT for HCV cirrhosis at a single centre over a 10-year period were included. Two cohorts – those who had received sirolimus IS (SRL group) compared to those on Calcineurin inhibitors (CNI group) were compared. HCV recurrence was reported using the METAVIR score on serial biopsies. Details of anti-HCV treatment were collected for both cohorts, and data analysed using the chi-square test and ’t’ test ,as well as Kaplan-Meier method for survival analysis. Results: There were 213 patients; 165 (77.6%) were male. SRL was used in 123 (57.6%). Median time to HCV recurrence was 7.1 months (range 1-129 months) while the median follow-up time was 49.1 months (1-146 months). SRL therapy did not affect HCV recurrence or survival after LT; however progression of disease activity and fibrosis was significantly lower in patients on SRL (change in fibrosis score 0.4+1.2 in SRL group vs 0.8+1.1 in the CNI group; p=0.05). Anti-HCV treatment was used in75 patients ( 35 in the CNI group ,40 in the SRL group), of whom 52 have completed planned therapy (median duration of treatment 11 months (1-30 months). More patients in the SRL group had to discontinue treatment. (4 in the CNI group vs 10 in the SRL group). In patients who had completed therapy, those on SRL IS demonstrated a trend to a higher SVR rate, which did not reach statistical significance. (59.8% SVR in the SRL group vs 38.3% on CNI alone; p=0.3). Conclusion: SRL IS in patients with recurrent HCV disease post-LT decreases the histologic progression of disease on serial biopsy. Patients on SRL appear to have a higher SVR rate with anti-HCV therapy.

Disclosure: All authors have declared no conflicts of interest.