IL-2 Receptor Antagonist (Basiliximab) Is Associated with Rapid Fibrosis Progression in Patients with Recurrent Hepatitis C after Liver Transplantation
Background: Recurrence of hepatitis C virus (HCV) infection following orthotopic liver transplantation (OLT) is universal. There is paucity of data on the safety and efficacy of interleukin (IL)-2 receptor antagonist (IL-2RA) when added to the standard immunosuppression regimen in OLT recipients wit...
| Main Authors: | , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Shiraz University of Medical Sciences
2010-01-01
|
| Series: | International Journal of Organ Transplantation Medicine |
| Subjects: | |
| Online Access: | http://home.sums.ac.ir/~habibzaf/ojs/index.php/IJOTM/article/view/3/17 |
| _version_ | 1818996573134127104 |
|---|---|
| author | Ibrahim A. Hanouneh Nizar N. Zein Rocio Lopez Lisa Yerian John Fung Bijan Eghtesad |
| author_facet | Ibrahim A. Hanouneh Nizar N. Zein Rocio Lopez Lisa Yerian John Fung Bijan Eghtesad |
| author_sort | Ibrahim A. Hanouneh |
| collection | DOAJ |
| description | Background: Recurrence of hepatitis C virus (HCV) infection following orthotopic liver transplantation (OLT) is universal. There is paucity of data on the safety and efficacy of interleukin (IL)-2 receptor antagonist (IL-2RA) when added to the standard immunosuppression regimen in OLT recipients with recurrent HCV infection.Objectives: To evaluate the efficacy of IL-2RA (Basiliximab) in preventing acute cellular rejection (ACR) in patients with recurrent HCV infection after OLT and to assess the impact of IL-2RA in promoting fibrosis progression in post-OLT recurrent HCV infection.Methods: Using an electronic pathology database, we identified all OLT/HCV patients with at least 2 post-OLT liver biopsies (1998–2006). Standard immunosuppression consisted of steroids and calcineurin inhibitor with and without mycophenolate mofetil. All patients who were transplanted after May 2004 received IL-2RA induction therapy. The Ludwig-Batts system was used to stage all biopsies (593 biopsies from 124 patients). The first biopsy that showed post-OLT fibrosis or the last follow-up biopsy was used for time-to-progression analysis. Univariate and multivariate Cox proportional hazards regression analyses were performed to identify factors associated with the progression of fibrosis.Results: ACR was significantly (p<0.001) lower in patients who received IL-2RA (20 of 70, 29%) compared to those who did not (33 of 54, 61%). The median (25%ile, 75%ile) follow-up was 12.1 (6.1, 23.9) months during which 61% of patients had progression of fibrosis. Univariate analysis revealed that a higher HCV RNA load at 4 months post-OLT (p=0.002), cytomegalovirus (CMV) infection (p<0.001), use of steroid therapy for ACR (p=0.043), and use of IL-2RA (p<0.001) were associated with higher hazards for the progressionof fibrosis. Viral load at 4 months post-OLT was significantly (p=0.025) higher in patients who had IL-2RA therapy (median [25%ile, 75%ile]: 2.9 [1.0, 5.0] ×106 vs. 1.4 [1.0, 2.3] ×106). In multivariate analysis, patients who received IL-2RA therapy were 3.1 (95% CI: 1.8–5.3) times more likely to develop fibrosisthan those who did not treated with IL-2RA. Steroid therapy for ACR remained significantly (Hazard Ratio=2.9, p=0.002) associated with the progression of fibrosis.Conclusion: IL-2RA (Basiliximab) decreases the rate of ACR. However, it may be associated with more rapid histological progression of the disease in post-OLT recurrent HCV. |
| first_indexed | 2024-12-20T21:31:53Z |
| format | Article |
| id | doaj.art-0b3d546dd8e24a6e90a521aeb30dccec |
| institution | Directory Open Access Journal |
| issn | 2008-6490 2008-6482 |
| language | English |
| last_indexed | 2024-12-20T21:31:53Z |
| publishDate | 2010-01-01 |
| publisher | Shiraz University of Medical Sciences |
| record_format | Article |
| series | International Journal of Organ Transplantation Medicine |
| spelling | doaj.art-0b3d546dd8e24a6e90a521aeb30dccec2022-12-21T19:26:02ZengShiraz University of Medical SciencesInternational Journal of Organ Transplantation Medicine2008-64902008-64822010-01-0111714IL-2 Receptor Antagonist (Basiliximab) Is Associated with Rapid Fibrosis Progression in Patients with Recurrent Hepatitis C after Liver TransplantationIbrahim A. HanounehNizar N. ZeinRocio LopezLisa YerianJohn FungBijan EghtesadBackground: Recurrence of hepatitis C virus (HCV) infection following orthotopic liver transplantation (OLT) is universal. There is paucity of data on the safety and efficacy of interleukin (IL)-2 receptor antagonist (IL-2RA) when added to the standard immunosuppression regimen in OLT recipients with recurrent HCV infection.Objectives: To evaluate the efficacy of IL-2RA (Basiliximab) in preventing acute cellular rejection (ACR) in patients with recurrent HCV infection after OLT and to assess the impact of IL-2RA in promoting fibrosis progression in post-OLT recurrent HCV infection.Methods: Using an electronic pathology database, we identified all OLT/HCV patients with at least 2 post-OLT liver biopsies (1998–2006). Standard immunosuppression consisted of steroids and calcineurin inhibitor with and without mycophenolate mofetil. All patients who were transplanted after May 2004 received IL-2RA induction therapy. The Ludwig-Batts system was used to stage all biopsies (593 biopsies from 124 patients). The first biopsy that showed post-OLT fibrosis or the last follow-up biopsy was used for time-to-progression analysis. Univariate and multivariate Cox proportional hazards regression analyses were performed to identify factors associated with the progression of fibrosis.Results: ACR was significantly (p<0.001) lower in patients who received IL-2RA (20 of 70, 29%) compared to those who did not (33 of 54, 61%). The median (25%ile, 75%ile) follow-up was 12.1 (6.1, 23.9) months during which 61% of patients had progression of fibrosis. Univariate analysis revealed that a higher HCV RNA load at 4 months post-OLT (p=0.002), cytomegalovirus (CMV) infection (p<0.001), use of steroid therapy for ACR (p=0.043), and use of IL-2RA (p<0.001) were associated with higher hazards for the progressionof fibrosis. Viral load at 4 months post-OLT was significantly (p=0.025) higher in patients who had IL-2RA therapy (median [25%ile, 75%ile]: 2.9 [1.0, 5.0] ×106 vs. 1.4 [1.0, 2.3] ×106). In multivariate analysis, patients who received IL-2RA therapy were 3.1 (95% CI: 1.8–5.3) times more likely to develop fibrosisthan those who did not treated with IL-2RA. Steroid therapy for ACR remained significantly (Hazard Ratio=2.9, p=0.002) associated with the progression of fibrosis.Conclusion: IL-2RA (Basiliximab) decreases the rate of ACR. However, it may be associated with more rapid histological progression of the disease in post-OLT recurrent HCV.http://home.sums.ac.ir/~habibzaf/ojs/index.php/IJOTM/article/view/3/17Transplantationliverinterleukin receptor antagonisthepatitis C virusliver fibrosiscirrhosis |
| spellingShingle | Ibrahim A. Hanouneh Nizar N. Zein Rocio Lopez Lisa Yerian John Fung Bijan Eghtesad IL-2 Receptor Antagonist (Basiliximab) Is Associated with Rapid Fibrosis Progression in Patients with Recurrent Hepatitis C after Liver Transplantation International Journal of Organ Transplantation Medicine Transplantation liver interleukin receptor antagonist hepatitis C virus liver fibrosis cirrhosis |
| title | IL-2 Receptor Antagonist (Basiliximab) Is Associated with Rapid Fibrosis Progression in Patients with Recurrent Hepatitis C after Liver Transplantation |
| title_full | IL-2 Receptor Antagonist (Basiliximab) Is Associated with Rapid Fibrosis Progression in Patients with Recurrent Hepatitis C after Liver Transplantation |
| title_fullStr | IL-2 Receptor Antagonist (Basiliximab) Is Associated with Rapid Fibrosis Progression in Patients with Recurrent Hepatitis C after Liver Transplantation |
| title_full_unstemmed | IL-2 Receptor Antagonist (Basiliximab) Is Associated with Rapid Fibrosis Progression in Patients with Recurrent Hepatitis C after Liver Transplantation |
| title_short | IL-2 Receptor Antagonist (Basiliximab) Is Associated with Rapid Fibrosis Progression in Patients with Recurrent Hepatitis C after Liver Transplantation |
| title_sort | il 2 receptor antagonist basiliximab is associated with rapid fibrosis progression in patients with recurrent hepatitis c after liver transplantation |
| topic | Transplantation liver interleukin receptor antagonist hepatitis C virus liver fibrosis cirrhosis |
| url | http://home.sums.ac.ir/~habibzaf/ojs/index.php/IJOTM/article/view/3/17 |
| work_keys_str_mv | AT ibrahimahanouneh il2receptorantagonistbasiliximabisassociatedwithrapidfibrosisprogressioninpatientswithrecurrenthepatitiscafterlivertransplantation AT nizarnzein il2receptorantagonistbasiliximabisassociatedwithrapidfibrosisprogressioninpatientswithrecurrenthepatitiscafterlivertransplantation AT rociolopez il2receptorantagonistbasiliximabisassociatedwithrapidfibrosisprogressioninpatientswithrecurrenthepatitiscafterlivertransplantation AT lisayerian il2receptorantagonistbasiliximabisassociatedwithrapidfibrosisprogressioninpatientswithrecurrenthepatitiscafterlivertransplantation AT johnfung il2receptorantagonistbasiliximabisassociatedwithrapidfibrosisprogressioninpatientswithrecurrenthepatitiscafterlivertransplantation AT bijaneghtesad il2receptorantagonistbasiliximabisassociatedwithrapidfibrosisprogressioninpatientswithrecurrenthepatitiscafterlivertransplantation |