Splenectomy prior to antiviral therapy in patients with hepatitis C virus related decompensated cirrhosis.

Abstract

Patients with hepatitis C virus-related decompensated cirrhosis can benefit from interferon-based antiviral therapy, but the common complication of cytopenia is a contraindication for this treatment. Splenectomy prior to interferon therapy may alleviate this problem. To investigate whether splenectomy improves the efficacy of antiviral therapy, 13 interferon-naïve hepatitis C virus decompensated cirrhotic patients underwent splenectomy between January 2008 and January 2011, followed 1-3 months later by an interferon-based therapeutic regimen (pegylated/standard interferon-α combined with ribavirin for 48 weeks). Ten (76.9%) of the patients developed postoperative complications, which included minor portal vein thrombosis (2/13, 15.4%) and transient ascites (8/13, 61.5%). At one-month post-splenectomy, the patients showed significantly increased platelet (pre-surgery: 48.2±15.9 vs. 186.0±70.6×10(3)μL(-1), p<0.001) and leukocyte (2.1±0.5 vs. 5.7±1.4×10(3)μL(-1), p<0.001) counts. Eight (61.5%) of the patients achieved sustained virological response, including all HCV genotype 2a-infected patients (4/4, 100%) and some of the genotype 1b-infected patients (4/9, 44.4%). Temporary interferon-α suspension was required for one patient to address severe intestinal infection. These results indicate that splenectomy prior to interferon-based therapy was safe and may facilitate adherence to subsequent antiviral therapy in selected HCV cirrhotic patients with portal hypertension and hypersplenism.

• Authors: Fanpu Ji, Shu Zhang, Na Huang, Hong Deng, Zongfang Li
• Journal: The Brazilian journal of infectious diseases : an official publication of the Brazilian Society of Infectious Diseases (Braz J Infect Dis) 2013 Sep-Oct Vol. 17 Issue 5 Pg. 601-5 ISSN: 1678-4391 [Electronic] Brazil
• PMID: 23830054 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
• Copyright: Copyright © 2013 Elsevier Editora Ltda. All rights reserved.

Chemical References

• Antiviral Agents
• Interferon-alpha
• Ribavirin

Topics

• Adult
• Antiviral Agents (administration & dosage)
• Female
• Genotype
• Hepatitis C, Chronic (complications, drug therapy, surgery)
• Humans
• Interferon-alpha (administration & dosage)
• Liver Cirrhosis (drug therapy, virology)
• Male
• Middle Aged
• Ribavirin (administration & dosage)
• Splenectomy
• Treatment Outcome