The Role of Iron in Hepatitis C Infection

Iron overload of varying degrees is common among patients with chronic hepatitis C. The clinical significance of this iron overload is uncertain. Studies that have evaluated the effect of hepatic iron stores on the response to anti-viral treatment or on the natural history of chronic hepatitis C have found variable results depending on the technique used to measure hepatic iron stores and the degree of iron overload present among the study population. We have tried to comprehensively analyze the literature regarding the clinical interaction between iron overload and the natural history of chronic hepatitis C. The one clear relationship that emerges is that pre treatment serum ferritin inversely correlates with the odds of achieving sustained virological(SVR) response after combination interferon ribavirin treatment. We have also reviewed the limited literature that reports the effect of therapeutic phlebotomy to reverse iron overload among patients with chronic hepatitis C. A small meta-analysis of 6 prospective randomized trials and a subsequent seventh trial do suggest that phlebotomy to induce iron depletion enhances the likelihood of achieving (SVR) after anti-viral therapy. However, these studies are primarily in patients receiving interferon monotherapy, which is of course now obsolete. Finally, a few small studies suggest that therapeutic phlebotomy to induce iron depletion reduces liver transaminase levels and may improve histology, and perhaps even reduce the risk of hepato-cellular carcinoma. Prospective randomized controlled trials of phlebotomy among patients with advanced hepatitis C and iron overload are needed.     

Does a positive pretransplant crossmatch affect long-term outcome in liver transplantation?

Despite the historical success of liver transplantation in the face of a positive lymphocytic crossmatch, increased incidence of acute cellular rejection and graft loss have been reported in this setting. Given the potential adverse effects of antirejection treatment, especially in hepatitis C virus-positive recipients, identification of predisposing factors could allow for better surveillance, avoidance of rejection, and potentially better graft outcomes.     

Risk of venous thromboembolism in patients hospitalized with heart failure

Because of uncertainty about the prevalence of pulmonary embolism (PE) and deep venous thrombosis (DVT) in hospitalized patients with congestive heart failure (CHF), data from the National Hospital Discharge Survey were investigated. Among hospitalized patients with CHF, PE was diagnosed in 0.73% and DVT in 1.03%. The relative risk for PE in patients with CHF compared with patients with no CHF was 2.15; for DVT, it was 1.21. The relative risk for PE in patients with CHF was greatest in patients <40 years of age (relative risk 11.72), and the relative risk for DVT was 5.46. In conclusion, a high relative risk for PE, DVT, and venous thromboembolism was shown in patients with CHF who were <60 years of age.