Premium
Effect of calcineurin inhibitors on survival and histologic disease severity in HCV‐infected liver transplant recipients
Author(s) -
Berenguer Marina,
Aguilera Victoria,
Prieto Martín,
San Juan Fernando,
Rayón José M.,
Benlloch Salvador,
Berenguer Joaquín
Publication year - 2006
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.20655
Subject(s) - medicine , tacrolimus , immunosuppression , liver transplantation , calcineurin , gastroenterology , hepatitis c , cirrhosis , liver biopsy , liver disease , hepatitis c virus , transplantation , biopsy , immunology , virus
The severity of recurrent hepatitis C virus (HCV) is likely related to several factors. Controversial results have been reported regarding the effect of specific calcineurin‐inhibitors. The aim of this research was to determine whether there are differences on posttransplantation outcome in HCV‐infected patients based on initial immunosuppression. Prospective randomized trial comparing tacrolimus vs. cyclosporine‐based immunosuppression in a cohort of patients undergoing primary orthotopic liver transplantation between 2001 and 2003 was used. Yearly biopsies were performed. Patients with at least 1 protocol biopsy and those with very severe recurrence despite a follow‐up of less than 1 yr (cholestatic hepatitis, progression to bridging fibrosis/cirrhosis) were included. Baseline characteristics (demographics, liver function at transplantation, genotype distribution, donor, surgery, immunosuppression except for the type of calcineurin inhibitor) did not differ between the 2 groups. Severe disease (defined as bridging fibrosis, cirrhosis, cholestatic hepatitis, and/or death due to recurrent disease in the first year) was present in 27 in 90 (30%), and was equally distributed in the cyclosporine and tacrolimus groups (15/46 vs. 12/44, respectively). A total of 33 in 90 (37%) patients had no fibrosis in the first year biopsy with no difference between the cyclosporine and tacrolimus groups (36.5 vs. 37%). The percentage of patients developing recurrent acute hepatitis was also similar (32% vs 35%); time to acute hepatitis though was shorter in the tacrolimus group (59 days [35‐185] vs. 92 days [39‐343] in the cyclosporin group; P = 0.02). Cholestatic hepatitis was observed in 4 of 44 and 5 of 46 patients under cyclosporine and tacrolimus, respectively ( P = not significant). In conclusions, the short‐term posttransplantation course of hepatitis C is not related to the calcineurin inhibitor used. Liver Transpl 12:762–767, 2006. © 2006 AASLD.