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Impact of tacrolimus versus cyclosporine in hepatitis C virus‐infected liver transplant recipients on recurrent hepatitis: A prospective, randomized trial
Author(s) -
Martin Paul,
Busuttil Ronald W.,
Goldstein Robert M.,
Crippin Jeffrey S.,
Klintmalm Goran B.,
Fitzsimmons William E.,
Uleman Carol
Publication year - 2004
Publication title -
liver transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.814
H-Index - 150
eISSN - 1527-6473
pISSN - 1527-6465
DOI - 10.1002/lt.20222
Subject(s) - medicine , tacrolimus , immunosuppression , liver transplantation , hepatitis c virus , calcineurin , gastroenterology , cirrhosis , hepatitis c , randomized controlled trial , transplantation , immunology , virus
Hepatitis C virus (HCV)‐induced cirrhosis is the commonest indication for orthotopic 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 immunosuppression regimens in this increase, including potentially tacrolimus. We randomized 79 patients to receive tacrolimus or cyclosporine as primary immunosuppressant posttransplantation. A pathologist blinded to treatment reviewed serial liver biopsies. Month 12 cumulative probabilities of histological hepatitis C recurrence for tacrolimus‐ and cyclosporine‐treated patients were .38 and .54 ( P = .19) and failure / death were .25 and .28, respectively ( P = .789). Although cyclosporine‐treated patients had significantly larger increases in median serum HCV RNA levels (months 1, 6, and 12), no significant differences were observed between the two treatment arms in histologically‐diagnosed HCV recurrence / survival rates. In conclusion, choice of calcineurin inhibitors does not impact severity of recurrent HCV. (Liver Transpl 2004;10:1258–1262.)