A retrospective cohort study of partial splenic embolization for antiviral therapy in chronic hepatitis C with thrombocytopenia

[Guest guest]

http://www.springerlink.com/content/vr50n106012230n1/

Journal of Gastroenterology

DOI: 10.1007/s00535-011-0407-9Online Firstâ„¢

Original Article—Liver, Pancreas, and Biliary Tract

A retrospective cohort study of partial splenic embolization for antiviral

therapy in chronic hepatitis C with thrombocytopenia

Hiroki Tahara, Hitoshi Takagi, Ken Sato, Yasushi Shimada, Hiroki Tojima,

Tomoyuki Hirokawa, Tatsuya Ohyama, Katsuhiko Horiuchi, Atsushi Naganuma and

Hirotaka Arai, et al.

Abstract

Background

Although partial splenic embolization (PSE) is reportedly effective prior to

interferon (IFN)-based therapy, the number of subjects in these studies is

small, and the appropriate candidates and disease prognosis remain unknown.

Methods

PSE was performed in 30 patients with advanced hepatitis C who could not receive

IFN-based therapy because of thrombocytopenia, platelet counts of

≤100,000/mm3, and hypersplenism. Also, we compared 25 PSE-treated patients

with 23 PSE-untreated patients with thrombocytopenia receiving pegylated IFN

(PEG-IFN)-alpha 2b plus ribavirin over the same period.

Results

PSE significantly increased platelet and leukocyte counts. PSE was well

tolerated with no severe complications. All the patients could receive IFN-based

therapy. Discontinuation of therapy in the total cohort of PSE-treated patients

was not due to thrombocytopenia. Although PSE did not significantly increase the

sustained virological response (SVR) rate, it significantly maintained higher

platelet counts throughout the observation period and increased the percentage

of patients with 100% adherence to PEG-IFN in the total controlled study

population and in subjects with genotype 2. In PSE-treated patients with

genotype 2, a trend towards increased SVR was noted. Four patients developed

hepatocellular carcinoma (HCC) at a median of 14.5 months after PSE, even though

two of these patients had achieved an SVR.

Conclusions

IFN-based therapy following PSE had an advantage in the maintenance of higher

platelet counts, and PSE possibly caused an increase in adherence to PEG-IFN.

Although patients with genotype 2 might be better candidates for PSE, further

evaluation is needed. Careful follow-up of PSE-treated patients, even though

they may have achieved an SVR, is needed to detect HCC.

[Guest guest]

http://www.springerlink.com/content/vr50n106012230n1/

Journal of Gastroenterology

DOI: 10.1007/s00535-011-0407-9Online Firstâ„¢

Original Article—Liver, Pancreas, and Biliary Tract

A retrospective cohort study of partial splenic embolization for antiviral

therapy in chronic hepatitis C with thrombocytopenia

Hiroki Tahara, Hitoshi Takagi, Ken Sato, Yasushi Shimada, Hiroki Tojima,

Tomoyuki Hirokawa, Tatsuya Ohyama, Katsuhiko Horiuchi, Atsushi Naganuma and

Hirotaka Arai, et al.

Abstract

Background

Although partial splenic embolization (PSE) is reportedly effective prior to

interferon (IFN)-based therapy, the number of subjects in these studies is

small, and the appropriate candidates and disease prognosis remain unknown.

Methods

PSE was performed in 30 patients with advanced hepatitis C who could not receive

IFN-based therapy because of thrombocytopenia, platelet counts of

≤100,000/mm3, and hypersplenism. Also, we compared 25 PSE-treated patients

with 23 PSE-untreated patients with thrombocytopenia receiving pegylated IFN

(PEG-IFN)-alpha 2b plus ribavirin over the same period.

Results

PSE significantly increased platelet and leukocyte counts. PSE was well

tolerated with no severe complications. All the patients could receive IFN-based

therapy. Discontinuation of therapy in the total cohort of PSE-treated patients

was not due to thrombocytopenia. Although PSE did not significantly increase the

sustained virological response (SVR) rate, it significantly maintained higher

platelet counts throughout the observation period and increased the percentage

of patients with 100% adherence to PEG-IFN in the total controlled study

population and in subjects with genotype 2. In PSE-treated patients with

genotype 2, a trend towards increased SVR was noted. Four patients developed

hepatocellular carcinoma (HCC) at a median of 14.5 months after PSE, even though

two of these patients had achieved an SVR.

Conclusions

IFN-based therapy following PSE had an advantage in the maintenance of higher

platelet counts, and PSE possibly caused an increase in adherence to PEG-IFN.

Although patients with genotype 2 might be better candidates for PSE, further

evaluation is needed. Careful follow-up of PSE-treated patients, even though

they may have achieved an SVR, is needed to detect HCC.

[Guest guest]

http://www.springerlink.com/content/vr50n106012230n1/

Journal of Gastroenterology

DOI: 10.1007/s00535-011-0407-9Online Firstâ„¢

Original Article—Liver, Pancreas, and Biliary Tract

A retrospective cohort study of partial splenic embolization for antiviral

therapy in chronic hepatitis C with thrombocytopenia

Hiroki Tahara, Hitoshi Takagi, Ken Sato, Yasushi Shimada, Hiroki Tojima,

Tomoyuki Hirokawa, Tatsuya Ohyama, Katsuhiko Horiuchi, Atsushi Naganuma and

Hirotaka Arai, et al.

Abstract

Background

Although partial splenic embolization (PSE) is reportedly effective prior to

interferon (IFN)-based therapy, the number of subjects in these studies is

small, and the appropriate candidates and disease prognosis remain unknown.

Methods

PSE was performed in 30 patients with advanced hepatitis C who could not receive

IFN-based therapy because of thrombocytopenia, platelet counts of

≤100,000/mm3, and hypersplenism. Also, we compared 25 PSE-treated patients

with 23 PSE-untreated patients with thrombocytopenia receiving pegylated IFN

(PEG-IFN)-alpha 2b plus ribavirin over the same period.

Results

PSE significantly increased platelet and leukocyte counts. PSE was well

tolerated with no severe complications. All the patients could receive IFN-based

therapy. Discontinuation of therapy in the total cohort of PSE-treated patients

was not due to thrombocytopenia. Although PSE did not significantly increase the

sustained virological response (SVR) rate, it significantly maintained higher

platelet counts throughout the observation period and increased the percentage

of patients with 100% adherence to PEG-IFN in the total controlled study

population and in subjects with genotype 2. In PSE-treated patients with

genotype 2, a trend towards increased SVR was noted. Four patients developed

hepatocellular carcinoma (HCC) at a median of 14.5 months after PSE, even though

two of these patients had achieved an SVR.

Conclusions

IFN-based therapy following PSE had an advantage in the maintenance of higher

platelet counts, and PSE possibly caused an increase in adherence to PEG-IFN.

Although patients with genotype 2 might be better candidates for PSE, further

evaluation is needed. Careful follow-up of PSE-treated patients, even though

they may have achieved an SVR, is needed to detect HCC.

[Guest guest]

http://www.springerlink.com/content/vr50n106012230n1/

Journal of Gastroenterology

DOI: 10.1007/s00535-011-0407-9Online Firstâ„¢

Original Article—Liver, Pancreas, and Biliary Tract

A retrospective cohort study of partial splenic embolization for antiviral

therapy in chronic hepatitis C with thrombocytopenia

Hiroki Tahara, Hitoshi Takagi, Ken Sato, Yasushi Shimada, Hiroki Tojima,

Tomoyuki Hirokawa, Tatsuya Ohyama, Katsuhiko Horiuchi, Atsushi Naganuma and

Hirotaka Arai, et al.

Abstract

Background

Although partial splenic embolization (PSE) is reportedly effective prior to

interferon (IFN)-based therapy, the number of subjects in these studies is

small, and the appropriate candidates and disease prognosis remain unknown.

Methods

PSE was performed in 30 patients with advanced hepatitis C who could not receive

IFN-based therapy because of thrombocytopenia, platelet counts of

≤100,000/mm3, and hypersplenism. Also, we compared 25 PSE-treated patients

with 23 PSE-untreated patients with thrombocytopenia receiving pegylated IFN

(PEG-IFN)-alpha 2b plus ribavirin over the same period.

Results

PSE significantly increased platelet and leukocyte counts. PSE was well

tolerated with no severe complications. All the patients could receive IFN-based

therapy. Discontinuation of therapy in the total cohort of PSE-treated patients

was not due to thrombocytopenia. Although PSE did not significantly increase the

sustained virological response (SVR) rate, it significantly maintained higher

platelet counts throughout the observation period and increased the percentage

of patients with 100% adherence to PEG-IFN in the total controlled study

population and in subjects with genotype 2. In PSE-treated patients with

genotype 2, a trend towards increased SVR was noted. Four patients developed

hepatocellular carcinoma (HCC) at a median of 14.5 months after PSE, even though

two of these patients had achieved an SVR.

Conclusions

IFN-based therapy following PSE had an advantage in the maintenance of higher

platelet counts, and PSE possibly caused an increase in adherence to PEG-IFN.

Although patients with genotype 2 might be better candidates for PSE, further

evaluation is needed. Careful follow-up of PSE-treated patients, even though

they may have achieved an SVR, is needed to detect HCC.