Source: DGNews  |  Posted 2 years ago

By Cheryl Lathrop

BOSTON -- November 5, 2009 -- The outcome for patients undergoing a liver
transplant for hepatitis C virus (HCV)-related liver disease is not affected by
the calcineurin inhibitor chosen for treatment, according to a study presented
here at the Liver Meeting 2009, the 60th Annual Meeting of the American
Association for the Study of Liver Diseases (AASLD).

Victoria Aguilera, Hepatogastroenterology Service, Hospital Universitario La
Fe, Valencia, Spain, and colleagues reported findings from their prospective,
randomised study on October 31.

In one-third of liver transplants, recurrent hepatitis C is aggressive.
Immunosuppression influences the natural history of this infection. In
HCV-infected transplant recipients, an association exists between the state of
the patient’s immunosuppression and the outcome after transplantation. However,
data are conflicted in regard to the potential effect of calcineurin inhibitors
on the outcome.

This study aimed to determine whether the choice of calcineurin inhibitor makes
a difference in survival and histologic outcome after transplantation. Results
from 310 patients who underwent liver transplantation between 2001 and 2007 and
were given tacrolimus (TAC) or cyclosporine (CSA) for immunosuppression.
Exclusion criteria were hepatitis B coinfection, HIV, negative HCV-RNA post
transplantation, combined liver-kidney or lung transplantation, or
retransplantation; 55 patients were excluded. Patient demographics were similar
in the 2 arms: roughly 75% men, mean age 56 years, 40% with hepatocellular
carcinoma, and about 25% alcohol users.

The primary endpoint was progression to severe disease, ie, bridging fibrosis,
cirrhosis, cholestatic hepatitis, or death due to recurrent hepatitis C, within
the first 2 years. Secondary endpoints were progression to fibrosis >1
determined by the first-year liver biopsy, the percentage of patients
developing cholestatic hepatitis, no fibrosis in the first-year liver biopsy,
and graft/patient survival. Liver biopsies were performed at 1- or 2-year
intervals, and the antiviral treatment was chosen based on the results of the
first-year biopsy.

The histologic outcome was similar for both groups: 29% of CSA and 23% of TAC
patients had bridging fibrosis or cirrhosis, 6% of both groups had cholestatic
hepatitis, 44% of CSA and 30% of TAC patients had fibrosis >1 the first year
after transplantation, and 21% of CSA and 28% of TAC patients had no fibrosis 1
year after transplantation. Patient survival was also similar in the groups
(P = .4).

Based on the results, the researchers concluded that post-transplantation
outcome was not related to the choice of calcineurin inhibitor used.

Presentation title: Calcineurin Inhibitors and Outcome of Liver
Transplantation in HCV-Positive Recipients: Final Results of a Prospective
Randomized Study. Abstract 511