Risk for immune-mediated graft dysfunction in liver transplant recipients with recurrent HCV infection treated with pegylated interferon

Josh Levitsky*, Maria Isabel Fiel, John P. Norvell, Edward Wang, Kymberly D. Watt, Michael P. Curry, Sumeet Tewani, Timothy M. McCashland, Maarouf A. Hoteit, Abraham Shaked, Samuel Saab, Amanda C. Chi, Amy Tien, Thomas D. Schiano

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

97 Scopus citations

Abstract

Background & Aims: Patients with recurrent hepatitis C virus infection treated with pegylated interferon (PEG) after liver transplantation can develop severe immune-mediated graft dysfunction (IGD) characterized by plasma cell hepatitis or rejection. Methods: We conducted a multicenter case-control study of 52 liver transplant recipients with hepatitis C to assess the incidence of, risk factors for, and outcomes of PEG-IGD. Data from each patient were compared with those from 2 matched patients who did not develop PEG-IGD (n = 104). We performed a multivariate analysis of risk factors and analyzed treatment and outcomes of graft dysfunction subtypes. Results: Overall incidence of PEG-IGD during a 10-year study period was 7.2%. Risk factors included no prior PEG therapy (odds ratio = 5.3; P <.0001), therapy with PEGα-2a (odds ratio = 4.7; P =.03), and immune features (mainly plasma cell hepatitis) on pre-PEG therapy liver biopsies (odds ratio = 3.9; P =.005). The PEG-IGD group had lower long-term patient (61.5% vs 91.3% of controls) and graft (38.5% vs 85.6% of controls) survival and higher rates of retransplantation (34.6% vs 6.7% of controls) (all, P <.0001), without increases in sustained virologic response. Variables associated with increased mortality included acute rejection as the PEG-IGD sub-type (hazard ratio [HR] = 2.4; P =.002), a high level of alkaline phosphatase at PEG initiation (HR = 1.003; P =.005), and lack of a sustained virologic response (HR = 3.3; P =.04). Variables associated with graft failure included a high level of alkaline phosphatase at PEG initiation (HR = 1.002; P =.04) and lack of a sustained virologic response (HR = 2.1; P =.04). Conclusions: PEG-IGD has high morbidity and mortality and is not associated with increased rates of virologic response. It is important to avoid PEG therapy in liver transplant recipients with specific clinical, biochemical, and histologic risk factors for PEG-IGD.

Original languageEnglish (US)
Pages (from-to)1132-1139.e1
JournalGastroenterology
Volume142
Issue number5
DOIs
StatePublished - May 2012

Funding

Funding This study was supported in part by an investigator-initiated grant (Josh Levitsky, principal investigator) from Schering-Plough/Merck Corporation . The funding source had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; and preparation, review, or approval of the manuscript.

Keywords

  • Immune Response
  • Immunosuppression
  • Organ Transplantation
  • Viral Hepatitis

ASJC Scopus subject areas

  • Hepatology
  • Gastroenterology

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