Antiviral therapy increases the risk of bacterial infections in HCV-infected cirrhotic patients awaiting liver transplantation: A retrospective study

• Published in: Journal of hepatology Vol. 50; no. 4; pp. 719 - 728
• Main Authors: Carrión, Jose A, Martínez-Bauer, Eva, Crespo, Gonzalo, Ramírez, Santseharay, Pérez-del-Pulgar, Sofia, García-Valdecasas, Juan Carlos, Navasa, Miquel, Forns, Xavier
• Format: Journal Article
• Language: English
• Published: Kidlington Elsevier B.V 01-04-2009; Elsevier
• Subjects: Adult; Aged; Antibiotics. Antiinfectious agents. Antiparasitic agents; Antiviral agents; Antiviral Agents - adverse effects; Antiviral Agents - therapeutic use; Bacterial Infections - epidemiology; Biological and medical sciences; Carcinoma, Hepatocellular - epidemiology; Cirrhosis; Female; Gastroenterology and Hepatology; Gastroenterology. Liver. Pancreas. Abdomen; Hepatitis C - complications; Hepatitis C - drug therapy; Humans; Incidence; Interferon; Interferon-alpha - adverse effects; Interferon-alpha - therapeutic use; Liver Transplantation; Liver, biliary tract, pancreas, portal circulation, spleen; Liver. Biliary tract. Portal circulation. Exocrine pancreas; Male; Medical sciences; Middle Aged; Norfloxacin prophylaxis; Other diseases. Semiology; Peritonitis - epidemiology; Peritonitis - microbiology; Pharmacology. Drug treatments; Polyethylene Glycols - adverse effects; Polyethylene Glycols - therapeutic use; Postoperative Complications - epidemiology; Postoperative Complications - microbiology; Recombinant Proteins; Recurrence; Ribavirin - adverse effects; Ribavirin - therapeutic use; Safety; Spontaneous bacterial peritonitis; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the digestive system; Time Factors; Viral Load; Virological response; Waiting Lists; Young Adult; EVR; Norfloxacin prophylaxis; end of treatment response; LT; alanine aminotransferase; ALT; UTI; SVR; Model for End-stage Liver Disease; SB; RVR; BR; early virological response; CCr; sustained virological response; hepatic encephalopathy; W; Virological response; hepatitis C virus; rapid virological response; SBP; biochemical response; creatinine clearance; EOT; Cirrhosis; MELD; spontaneous bacteremia; HCV; Interferon; spontaneous bacterial peritonitis; HE; Week; liver transplantation; urinary tract infection; Spontaneous bacterial peritonitis; Human; Spontaneous; Cytokine; Hepatic disease; Norfloxacin; Infection; Prevention; Fluoroquinolone derivatives; Treatment; Abdominal disease; Risk factor; Gastroenterology; Bacteriosis; Digestive diseases; Antiviral; Antibacterial agent; Quinolone derivatives; Peritonitis; Liver transplantation
• ISSN: 0168-8278; 1600-0641
• DOI: 10.1016/j.jhep.2008.11.015

Background/Aims Recurrence of hepatitis C after liver transplantation (LT) is universal and may cause premature graft loss. We evaluated the efficacy and safety of antiviral therapy in HCV-infected patients with decompensated cirrhosis awaiting LT. Methods Fifty-one patients underwent treatment with peginterferon-alfa-2a and ribavirin. A control group of 51 untreated individuals awaiting LT were matched by age, Child-Pugh and MELD scores and time on the waiting list. Results Case and control patients were comparable for all relevant variables. Fifteen treated patients (29%) had undetectable HCV-RNA at the time of transplantation and 10 (20%) achieved SVR. Early virological response and non-1 genotype were the strongest predictors of viral clearance. There was a higher incidence of bacterial infections in treated patients vs controls, particularly in Child-Pugh B-C individuals (17 vs 3 episodes) (log-rank = 0.0016). Importantly, the incidence of spontaneous bacterial peritonitis (SBP) in patients who were not receiving norfloxacin prophylaxis ( n = 83) was significantly higher in the treated group than in controls (log-rank = 0.01). Conclusions Our data demonstrate that antiviral treatment prevents hepatitis C recurrence in 20% of HCV-infected patients. However, treatment should be recommended with caution in individuals with poor liver function who do not receive norfloxacin prophylaxis for SBP, since it increases the risk of bacterial infections.