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

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.

Abbreviations: LT, liver transplantation, MELD, Model for End-stage Liver Disease, CCr, creatinine clearance, SB, spontaneous bacteremia, SBP, spontaneous bacterial peritonitis, RVR, rapid virological response, EVR, early virological response, EOT, end of treatment response, SVR, sustained virological response, UTI, urinary tract infection, HE, hepatic encephalopathy, W, Week, HCV, hepatitis C virus, ALT, alanine aminotransferase, BR, biochemical response

Keywords: Interferon, Cirrhosis, Spontaneous bacterial peritonitis, Norfloxacin prophylaxis, Virological response