ABSTRACT
Pakistan has a very high HCV prevalence[1] with majority being genotype 3. A high number of patients with cirrhosis undergo liver transplantation. HCV recurrence following transplant is universal[2]. Interferon free therapy has recently become available and preliminary studies show 70% SVR in post transplant patients[3]. Since genotype 3 has a high response to pegylated Interferon 3, it remains a competitive agent
Aims and Methods: The aim of this study was to determine the efficacy of pegylated interferon plus ribavirin in the treatment of recurrent hepatitis C following liver transplantation. 15 patients with recurrent hepatitis C following liver transplantation were included in the study, 13 males and 2 females. Mean age was 52 years. 13 had genotype 3 disease, one genotype 2 and one genotype 1.11 were living donor and 4 were cadaveric grafts. 13 were on tacrolimus and MMF, one on tacrolimus alone and one on cyclosporine and MMF. 6 patients were treated within 2 years of transplant and remaining 9 were treated 3-5 years after transplant. Liver biopsy was done prior to therapy in 6 patients. All patients received pegylated interferon a2a 180 g weekly plus ribavirin 15mg/kg daily for 48 weeks
Results: 14 out of 15 patients [93.3%] achieved SVR. This included all 13 Genotype 3 patients [100%] and the single genotype 2 patient. One patient, genotype 1, was nonresponder to treatment. Treatment was stopped at 22 and 36 weeks in 2 patients due to anaemia. Both achieved SVR. 11 patients were administered erythropoietin for anemia. 7 patients required ribavirin dose reduction for anemia, and achieved SVR despite dose reduction
Conclusion: Pegylated interferon and ribavirin is an extremely effective combination for treatment of patients with recurrent genotype 3 hepatitis C after liver transplantation. The main side effect is anaemia, which can be managed with erythropoietin supplementation and ribavirin dose reduction without any reduction in response rate
ABSTRACT
To determine the efficacy of Rifaximin in prevention of repeated episodes of hepatic encephalopathy in patients with liver cirrhosis as compared to placebo. Triple-blind, randomized placebo-controlled trial. Department of Gastroenterology-Hepatology, Shaikh Zayed Hospital, Lahore, from October 2012 to April 2013. Patients in remission from recurrent hepatic encephalopathy resulting from cirrhosis were randomly assigned to receive either Rifaximin, at a dose of 550 mg twice daily [63 patients], or placebo [63 patients.] Patients were requested to take the drug orally twice daily for 6 months or until they developed a breakthrough episode of hepatic encephalopathy. Mean age of patients in treatment and control group was 40.21 +/- 2.33 years and 42.87 +/- 4.54 years respectively. The most common etiology of cirrhosis was hepatitis C followed by hepatitis B. Patients who remained free of hepatic encephalopathy during study period were 40 out of 63 patients in control group and 35 patients out of 63 patients [p = 0.56]. Most of the patients who developed breakthrough hepatic encephalopathy had a MELD score range of 21-25 in both groups. The number of deaths and adverse events was similar in both groups. Over a 6-month period, treatment with Rifaximin failed to maintain remission from hepatic encephalopathy more effectively than placebo in the studied group.