Partial splenic embolization and peg‐IFN plus RBV in liver transplanted patients with hepatitis C recurrence: safety,efficacy and long‐term outcome

Bárcena R, Moreno A, Foruny JR, Blázquez J, Graus J, Riesco JM, Blesa C, García‐Hoz F, Sánchez J, Gil‐Grande L, Nuño J, Fortún J, Rodriguez‐Sagrado MA, Moreno A. Partial splenic embolization and peg‐IFN plus RBV in liver transplanted patients with hepatitis C recurrence: safety, efficacy and long‐term outcome.
Clin Transplant 2010: 24: 366–374. © 2009 John Wiley & Sons A/S. Abstract: Background: There is limited information on the long‐term outcome in liver transplant (LT) subjects undergoing partial splenic embolization (PSE) prior to full dose pegylated interferon/ribavirin (peg‐IFN/RBV). Methods: Retrospective review of eight LT subjects after PSE and antiviral therapy. Results: Baseline platelets and neutrophils were <50 000 cells/mL and <1000 cells/mL in 75% and 50%. Mean splenic infarction volume was 85 ± 13%. PSE produced major complications in three (37.5%): recurrent sterile netrophilic ascites and renal insufficiency (n = 2), and splenic abscess (n = 1). Full‐dose peg‐IFN/RBV was started in seven (87.5%), with two early withdrawals (28.6%) despite early virological response (toxicity and infection); both subjects died. Anemia led to RBV dose‐adjustment in six (86%), with human recombinant erythropoietin (EPO) use in four (57%). No peg‐IFN adjustments or granulocyte‐colonies stimulating factor were needed. Two patients reached sustained virological response (SVR) (28.6%). Two non‐responders maintained prolonged therapy with biochemical/histological improvement. After a median follow‐up of 151 wk, we observed significant improvements in hematological parameters, aspartate aminotransferase, alanine aminotransferase, international normalized ratio, and prothrombin activity. Conclusions: Extensive PSE after LT produced significant morbidity (37.5%). Peg‐IFN/RBV was completed in five out of seven (71%), with SVR in two (28.6%). RBV adjustement due to anemia was high despite EPO use. Only patients able to complete or maintain antiviral therapy survived, with long‐term significant benefits in hematological parameters and liver function tests.