1
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Abstract
Because of troublesome side effects associated with steroid use, many transplant centers have tried to withdraw steroids from stable, solid organ transplant recipients. The objective of this study was to evaluate the ability to wean liver transplant recipients off steroids, depending on both their primary immunosuppressive regimen and their primary disease state. This was a retrospective, single-center review of steroid weaning in adult orthotopic liver transplant recipients. Based on primary immunosuppression, patients could be weaned off steroids similarly if they were taking cyclosporine or tacrolimus (53.9% vs 61.4%). When triple immunosuppressive regimens were compared with dual regimens, a difference was found in ability to wean patients off steroids (52.4% vs 74.5%, P=.001). When steroid weaning was stratified for primary immunosuppression and primary disease state, patients with autoimmune-mediated diseases (autoimmune hepatitis, sclerosing cholangitis, and primary biliary cirrhosis) were less likely to be weaned if they were receiving cyclosporine-based immunosuppressants (36.8% vs 62.2%, P=.03). In conclusion, it appears that a large number of liver transplant recipients can safely be tapered off steroids.
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Affiliation(s)
- R W Adams
- Emory University Hospital, Atlanta, Ga., USA
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2
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Smallwood GA, Burns D, Fasola CG, Steiber AC, Heffron TG. Relationship Between Immunosuppression and Osteoporosis in an Outpatient Liver Transplant Clinic. Transplant Proc 2005; 37:1910-1. [PMID: 15919501 DOI: 10.1016/j.transproceed.2005.02.078] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND The aim of this study is to determine the relationship between immunosuppression, disease state, and osteoporosis in an outpatient liver transplant clinic. METHODS All liver transplant recipients visiting an outpatient transplant clinic received bone density scanning with a dual-energy X-ray absorptiometry (DEXA) device of the calcaneal bone after completing a questionnaire assessing risk and medications currently being used. RESULTS Of the 137 liver transplant (OLT) recipients completing questionnaires and receiving DEXA screening, patients with low bone density (n = 50) were older (56.6 +/- 12.7 years vs 50.2 +/- 10.1 years; P = .02) compared with normal density patients (n = 87) and were predominately female (64.0% vs 35.6%; P = .01). Based on disease state, patients with cholestatic liver failure had lower bone calcaneal area (17.3 +/- 1.3 cm2 vs 18.9 +/- 1.57 cm2; P < .01). Patients taking tacrolimus (n = 112), as compared with cyclosporine (n = 25), had a tendency toward fewer findings of low bone density (37.5% [42 of 112] vs 56.0% [14 of 25]; P = .08) but had more risk factors (3.1 +/- 1.2 vs 2.1 +/- 0.8; P = .001) and a higher prednisone dose (4.4 +/- 5.9 mg/d vs 2.1 +/- 3.8 mg/d; P = .026). For patients weaned from prednisone, the tacrolimus patients were less likely to have low bone density (36.2% vs 68.8%; P = .02). Mycophenolate mofetil did not influence bone density or area measured. CONCLUSIONS After liver transplantation, patients taking cyclosporine were more likely to have low bone density compared with those taking tacrolimus.
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Affiliation(s)
- G A Smallwood
- Department of Pharmacy, Emory University Hospital, Atlanta, Georgia 30322, USA.
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3
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Heffron TG, Smallwood GA, Ramcharan T, Davis L, Connor K, Martinez E, Stieber AC. Duct-to-duct biliary anastomosis for patients with sclerosing cholangitis undergoing liver transplantation. Transplant Proc 2004; 35:3006-7. [PMID: 14697962 DOI: 10.1016/j.transproceed.2003.10.035] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
BACKGROUND Due to the association of strictures within the biliary ductal system, Roux-en-Y choledochojejunostomy has been the preferred method of anastomosis for liver transplant recipients with primary sclerosing cholangitis (PSC). The aim of this study was to evaluate duct-to-duct anastomosis in patients with PSC who undergo liver transplantation. METHODS Data were collected and evaluated based on demographics, type of anastomosis preformed, malignancies, outcomes comparisons, and survival. RESULTS Of the 60 patients transplanted for PSC, 58 were diagnosed PSC prior to transplantation and 2 were diagnosed on explant. The Roux-en-Y group (n = 38) were similar in age, gender, and race when compared to the duct-to-duct (d-d) group (n = 22). There were similar rates of anastomotic revisions when comparing d-d anastomosis with Roux-en-Y (2 [9.1%] versus 2 [5.3%], P = NS) owing to bile leaks. Based on radiologic interventions of the bile ducts, seven (18.4%) in the Roux-en-Y group had interventions compared to two (9.1%) in the duct-to-duct group (P = NS). There was also no difference in recurrence of PSC: three (7.9%) in the Roux-en-Y group compared to two (5.3%) in the duct-to-duct group (P = NS). Survival at 4 years were similar between each group (76.5% [+/- 0.07] Roux-en-Y versus 84.9% [+/- 0.08] duct-to-duct, P = NS). CONCLUSION Duct-to-duct anastomosis at the time of liver transplantation is both safe and efficacious when used in patients with PSC. Outcomes as described by surgical interventions, radiologic interventions, retransplantation, and survival were similar between groups.
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Affiliation(s)
- T G Heffron
- Department of Surgery, Emory University School of Medicine, Atlanta, Georgia, USA
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4
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Heffron TG, Smallwood GA, Oakley B, Pillen T, Welch D, Connor K, Martinez E, Romero R, Stieber AC. Adult and pediatric liver transplantation for autoimmune hepatitis. Transplant Proc 2003; 35:1435-6. [PMID: 12826182 DOI: 10.1016/s0041-1345(03)00457-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Due to the early age that pediatric patients with autoimmune hepatitis (AIH) are transplanted, it is theorized that older AIH patients may have different outcomes than pediatric patients following liver transplantation. METHODS This is a retrospective review of both the adult and pediatric liver transplant programs consisting of 56 patients. Rejection and recurrence of AIH were determined by biopsy. RESULTS The autoimmune patient having rejection episodes had a 1.76-fold increase in relative risk to develop autoimmune recurrence when compared to patients without rejection [RR = 1.76; 95% CIRR (1.08, 2.86)]. The pediatric group had a 6.62-fold increase in relative risk to develop colitis following liver transplantation [RR = 6.62; 95% C.I.R.R. (1.36, 32.13); P =.02]. Mean days to recurrence of AIH were similar in both groups (1364 +/- 1074 vs 936; P = NS). There were more hospitalized days in the pediatric group compared to the adults (20.5 +/- 13.3 days vs 51.7 +/- 22.2 days, P =.039). OKT-3 was rarely used (n = 5) in either group (9.3% vs 7.7%, P = NS) and was not correlated with which patients would be weaned from steroids or recurrence. CONCLUSIONS Based on this review, pediatric patients were more likely to develop ulcerative colitis following liver transplantation and they incurred longer hospital stays than adults. The adult group was more likely to be weaned from steroids, with AIH recurrence unrelated to weaning.
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Affiliation(s)
- T G Heffron
- Department of Surgery, Emory University School of Medicine, Atlanta, Georgia 30322, USA
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5
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Smallwood GA, Davis L, Connor K, Martinez E, Stieber AC, Heffron TG. Nonresponders of interferon/ribavirin treatment for recurrent hepatitis C following liver transplantation. Transplant Proc 2003; 35:1476-7. [PMID: 12826197 DOI: 10.1016/s0041-1345(03)00458-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND Treatment of recurrent hepatitis C (HCV) following liver transplant currently includes alpha-interferon with ribavirin. OBJECTIVE The aim of this study is to evaluate nonresponder protocols for patients failing current treatment for recurrent hepatitis C following liver transplantation. METHODS From February 1998 through November 2002, 67 patients, all serum RNA-positive for hepatitis C with histological evidence of recurrent hepatitis C, underwent treatment with alpha-interferon and ribavirin. For patients who failed initial treatment, patients were begun on either amantadine along with interferon/ribavirin or peginterferon with ribavirin. RESULTS Of the initial 67 patients, there was a complete viral clearance in only 14.9% (10/67). Of the 57 remaining patients not clearing the virus, 30 (52.6%) were taken off treatment due to adverse events associated with bone marrow or hemoglobin suppression. In the amantadine group (n = 12), three (25%) had to discontinue due to CNS side effects of slurred speech, dizziness, and increased depression. In the amantadine group, no patients cleared the virus but there was a one log drop in viral load (1.6 x 10(6) vs 0.9 x 10(6); P =.4). In the peginterferon group, there were three (20%) patients with complete viral clearance during treatment with similar drops to amantadine. There was also seen a biochemical response by month 3 with peginterferon, which was not seen with amantadine. CONCLUSIONS Peginterferon with ribavirin appears to be superior to amantadine with interferon/ribavirin when used in nonresponders for hepatitis C viral clearance.
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Affiliation(s)
- G A Smallwood
- Department of Pharmacy, Emory University Hospital, Atlanta, Georgia, USA.
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6
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Abstract
PURPOSE Children have been reported to be at greater risk for hepatic artery thrombosis when compared to adults due to small arterial size, nonuse of intraoperative microscope, and postoperative hypercoagulable state. METHODS We evaluated arterial anastomosis type, intraoperative field magnification, and hepatic artery complications and how they were managed. All patients underwent ultrasound, anticoagulation consisted of 41 mg aspirin once a day, and 35 patients received alprostadil (PGE) for the first 7 days after transplantation. No patients were administered intravenous heparin following liver transplantation. RESULTS Of the 74 livers transplanted, 36 grafts (48.6%) were whole organ transplants and 38 grafts (51.4%) were partial livers. We observed HAT in 1 of 74 (1.35%) transplants in our pediatric liver transplant population. The only patient with HAT was a young girl with a history of biliary atresia. The occurrence of a hepatic artery thrombosis on day 7 was caused by the migration of an intimal plaque dissection within the artery graft. She was emergently taken back into the operating room for graft revision. This individual currently has a survival time of 426 days following her last transplant. CONCLUSIONS Hepatic artery thrombosis may be minimized in pediatric liver transplantation without the use of microsurgery. Anticoagulation utilizing ASA and alprostadil is sufficient to avoid HAT. Accurate use of ultrasound is crucial to avoid this complication. Graft and patient salvage is possible with expedient surgical treatment; microsurgery, anticoagulant therapy, site of arterial inflow, and recipient size and weight.
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Affiliation(s)
- T G Heffron
- Department of Surgery, Emory University School of Medicine, Atlanta, Georgia 30322, USA
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7
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Abstract
BACKGROUND Biliary complications in pediatric liver transplantation (PLT) are associated with increased morbidity and mortality. METHODS Prospectively, data was collected on 89 consecutive liver transplants performed in 82 children. Eighty-nine consecutive PLTs were tracked for transplant type (partial versus whole), recipient age/weight, duct anastomosis type, surgical technique, and biliary complications. Treatments of biliary complications (surgical versus interventional radiology) were also evaluated. RESULTS Forty-six children (51.7%) received partial transplants and 43 (48.3%) children received whole organs. The average age for whole liver transplanted children was 8.95 +/- 6.62 years and average weight was 36.2 +/- 28.7 kg; for those receiving partial livers, 3.19 +/- 3.52 years and 14.1 +/- 13.0 kg. Duct-to-duct anastomosis was performed for 26 grafts and Roux-en-Y choledochojejunostomy for 63 grafts. Biliary complications occurred in 10 of 89 (11.2%) grafts. Complications included anastomotic strictures in four (40%), bile leak in five (50%), intraparenchymal biloma in one (10%). The complication rate for whole organs was 1/43 (2.3%) and 9/46 (19.6%) for partial organ (P =. 015). No difference in complication rates were seen in type of ductal anastomosis (7.7% vs 12.7%, P = NS). Reoperation for biliary complication was necessary in only 2/10 (20%) of grafts. CONCLUSIONS Technical advances have reduced the incidence of biliary complications in PLT. Partial liver grafts have a statistically higher risk of biliary complication than whole grafts. Most biliary complications can be managed with radiological intervention without surgical exploration. Pediatric biliary complications are not associated with graft loss.
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Affiliation(s)
- T G Heffron
- Department of Surgery, Emory University School of Medicine, Atlanta, Georgia 30322, USA
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8
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Smallwood GA, Coloura CT, Martinez E, Stieber AC, Heffron TG. Can patients awaiting liver transplantation elicit an immune response to the hepatitis A vaccine? Transplant Proc 2002; 34:3289-90. [PMID: 12493448 DOI: 10.1016/s0041-1345(02)03572-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- G A Smallwood
- Department of Pharmacy, Emory University Hospital, Atlanta, Georgia 30322, USA
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9
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Heffron TG, Smallwood GA, Oakley B, Pillen T, Welch D, Martinez E, Romero R, Stieber AC. Autoimmune hepatitis following liver transplantation: relationship to recurrent disease and steroid weaning. Transplant Proc 2002; 34:3311-2. [PMID: 12493456 DOI: 10.1016/s0041-1345(02)03570-4] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- T G Heffron
- Department of Surgery, Emory University School of Medicine, Atlanta, Georgia 30322, USA
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10
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Smallwood GA, Coffey G, Davis L, Martinez E, Stieber AC, Heffron TG. Hepatitis C treatment outcomes of African Americans following liver transplantation. Transplant Proc 2002; 34:3317-8. [PMID: 12493459 DOI: 10.1016/s0041-1345(02)03573-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- G A Smallwood
- Department of Pharmacy, Emory University Hospital, Atlanta, Georgia 30322, USA
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11
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Norris ER, Smallwood GA, Connor K, McDonell K, Martinez E, Stieber AC, Heffron TG. Prevalence of depressive symptoms in patients being evaluated for liver transplantation. Transplant Proc 2002; 34:3285-6. [PMID: 12493446 DOI: 10.1016/s0041-1345(02)03571-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- E R Norris
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, Georgia 30322, USA
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12
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Smallwood GA, Wickman JM, Martinez E, Stieber AC, Heffron TG. Osteoporosis screening in an outpatient liver transplant clinic: impact of primary immunosuppression. Transplant Proc 2002; 34:1569-70. [PMID: 12176489 DOI: 10.1016/s0041-1345(02)03026-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- G A Smallwood
- Department of Pharmacy, Emory University Hospital Pharmacy, EG #22, 1364 Clifton Road NE, Atlanta, GA 30322, USA
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13
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Heffron TG, Smallwood GA, Pillen T, Davis L, Martinez E, Romero R, Stieber AC. Liver transplant induction trial of daclizumab to spare calcineurin inhibition. Transplant Proc 2002; 34:1514-5. [PMID: 12176462 DOI: 10.1016/s0041-1345(02)02952-4] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- T G Heffron
- Department of Surgery, Emory University School of Medicine, Atlanta, GA 30322, USA
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14
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Smallwood GA, Davis L, Martinez E, Stieber AC, Heffron TG. Mycophenolate's influence in the treatment of recurrent hepatitis c following liver transplantation. Transplant Proc 2002; 34:1559-60. [PMID: 12176484 DOI: 10.1016/s0041-1345(02)03021-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Affiliation(s)
- G A Smallwood
- Department of Pharmacy, Emory University Hospital Pharmacy, 1364 Clifton Road NE, Atlanta, GA 30322, USA
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15
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Heffron TG, Smallwood GA, Davis L, Martinez E, Stieber AC. Sirolimus-based immunosuppressive [correction of immunosuppresive] protocol for calcineurin sparing in liver transplantation. Transplant Proc 2002; 34:1522-3. [PMID: 12176466 DOI: 10.1016/s0041-1345(02)02956-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- T G Heffron
- Department of Surgery, Emory University School of Medicine, Atlanta, GA 30322, USA
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16
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Affiliation(s)
- R Romero
- Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta, Georgia, USA.
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17
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Abstract
Because of troublesome side effects associated with steroid use, many transplant centers have tried to withdraw steroids from stable, solid organ transplant recipients. The objective of this study was to evaluate the ability to wean liver transplant recipients off steroids, depending on both their primary immunosuppressive regimen and their primary disease state. This was a retrospective, single-center review of steroid weaning in adult orthotopic liver transplant recipients. Based on primary immunosuppression, patients could be weaned off steroids similarly if they were taking cyclosporine or tacrolimus (53.9% vs 61.4%). When triple immunosuppressive regimens were compared with dual regimens, a difference was found in ability to wean patients off steroids (52.4% vs 74.5%, P = .001). When steroid weaning was stratified for primary immunosuppression and primary disease state, patients with autoimmune-mediated diseases (autoimmune hepatitis, sclerosing cholangitis, and primary biliary cirrhosis) were less likely to be weaned if they were receiving cyclosporine-based immunosuppressants (36.8% vs 62.2%, P = .03). In conclusion, it appears that a large number of liver transplant recipients can safely be tapered off steroids.
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Affiliation(s)
- R W Adams
- Emory University Hospital, Atlanta, Ga., USA
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18
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De Vera ME, Smallwood GA, Rosado K, Davis L, Martinez E, Sharma S, Stieber AC, Heffron TG. Interferon-alpha and ribavirin for the treatment of recurrent hepatitis C after liver transplantation. Transplantation 2001; 71:678-86. [PMID: 11292302 DOI: 10.1097/00007890-200103150-00019] [Citation(s) in RCA: 81] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Initial studies utilizing interferon-alpha and ribavirin for the treatment of recurrent hepatitis C virus (HCV) infection after liver transplantation showed promising results. Here we report our single-center experience using this combination therapy. METHODS Liver transplant recipients with recurrent HCV (elevated serum aminotransferases, positive serum HCV RNA, and biopsy-proven hepatitis without rejection) received interferon-alpha (1.5-3 million units subcutaneously three times a week) and ribavirin (400-1000 mg p.o. daily) for 12 months or more. Serum aminotransferases, HCV RNA, and severity of hepatitis were followed. RESULTS Thirty-two patients have been treated for at least 3 months, including 13 who have been on 12 or more months of therapy. Three died from allograft failure due to recurrent HCV. Dose reductions of interferon-alpha and/or ribavirin occurred in 22 patients. Thirteen had their medications permanently discontinued for severe adverse effects. Twenty-six patients (81%) had a biochemical response (BR; normalization of serum aminotransferases) after 3 months. End-of-treatment and sustained BR were 77% and 71%, respectively. Mean viral loads decreased 68-77%; however, only three patients became serum HCV RNA negative. After 12 months of therapy, no histological improvement was observed in 11 patients who were biopsied. Patients who received mycophenolate mofetil or daclizumab had a less likelihood of achieving a BR. CONCLUSIONS A significant number of patients did not tolerate interferon-alpha or ribavirin. Although BR was excellent and mean viral loads decreased significantly, virological clearance was poor and no histological improvement was noted. A more efficacious treatment with less adverse effects for recurrent HCV after liver transplantation is needed.
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Affiliation(s)
- M E De Vera
- Department of Surgery, Emory University Medical School, Atlanta, Georgia 30322, USA.
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19
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Affiliation(s)
- G A Smallwood
- Department of Pharmacy, Emory University School of Medicine, Atlanta, Georgia, USA
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20
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Heffron TG, Pillen T, Smallwood GA, Martinez E, de Vera ME, Romero R. Single-dose induction with daclizumab immediately after liver transplantation in pediatric patients. Transplant Proc 2001; 33:1449. [PMID: 11267368 DOI: 10.1016/s0041-1345(00)02548-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Affiliation(s)
- T G Heffron
- Division of Liver Transplantation, Emory University Hospital, Atlanta, Georgia, USA
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21
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Affiliation(s)
- T G Heffron
- Department of Surgery, Emory University School of Medicine, Atlanta, Georgia, USA
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22
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Heffron TG, Smallwood GA, Stieber AC, Boyer TG. DACLIZUMAB INDUCTION IMMEDIATELY POST LIVER TRANSPLANTATION TO SPARE CALCINEURIN INHIBITORS. Transplantation 1999. [DOI: 10.1097/00007890-199904150-00127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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23
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Fried MW, Khudyakov YE, Smallwood GA, Cong M, Nichols B, Diaz E, Siefert P, Gutekunst K, Gordon RD, Boyer TD, Fields HA. Hepatitis G virus co-infection in liver transplantation recipients with chronic hepatitis C and nonviral chronic liver disease. Hepatology 1997; 25:1271-5. [PMID: 9141451 DOI: 10.1002/hep.510250536] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Hepatitis G virus (HGV) is a newly described RNA virus that is parenterally transmitted and has been found frequently in patients with chronic hepatitis C infection. To determine the impact of hepatitis G virus co-infection on morbidity and mortality following liver transplantation, we measured HGV RNA by polymerase chain reaction in pre and posttransplantation sera from a cohort of patients transplanted for chronic hepatitis C and a control group of patients transplanted for nonviral causes who were negative for hepatitis C virus (HCV) RNA in serum. The overall prevalence rate of HGV RNA in transplanted patients with chronic hepatitis C was 20.7%. HGV infection was present before transplantation in 13% while it appeared to have been acquired at the time of transplantation in 7.4%. Mean serum alanine aminotransferase activity, hepatic histological activity, and patient and graft survival were similar between HGV-positive and HGV-negative patients. The prevalence rate of HGV RNA in transplanted controls was 64% (P < .01) with a significantly higher rate of acquisition of HGV infection following transplantation (53%, P < .001) when compared with patients with chronic hepatitis C. Mean serum alanine aminotransferase activity was significantly lower in the control patients with HGV infection alone following transplantation than in patients co-infected with hepatitis C (37 +/- 9 vs. 70 +/- 33 U/L, P < .01). Thus, HGV is frequently found in transplantation patients co-infected with hepatitis C although it appears to have minimal clinical impact. In patients transplanted for nonviral causes of end-stage liver disease, a high rate of hepatitis G acquisition at the time of transplantation may occur but does not appear to predispose to chronic hepatitis.
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Affiliation(s)
- M W Fried
- Department of Medicine, Emory University School of Medicine, Atlanta, GA 30322, USA
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