1002 - Phlebotomy to Maintain Iron Depletion Reduces Alpha Fetoprotein and Reduces Incidence of Hepatoma and Improves Survival in Chronic Hepatitis C

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Introduction: Increased liver iron stores in chronic hepatitis C (CHC) patients correlates with poor clinical outcome and development of hepatoma (HCC). We present our experience with long-term maintenance phlebotomy in patients with advanced CHC and high alpha-fetoprotein (AFP) and compare their outcomes with a control population that did not undergo phlebotomy.

Methods: 33 CHC patients with a high AFP > 10 ng/ml underwent long-term maintenance phlebotomy starting in 2000. 16 patients had undergone combination anti-viral therapy with interferon and ribavirin but failed. 17 patients were considered for anti-viral therapy but were either disqualified or declined therapy. Liver biopsy showed cirrhosis in 14 patients, and bridging fibrosis in 7 patients. 12 patients demonstrated cirrhosis on imaging or clinical criteria. 110 control patients with CHC and an AFP >10 and negative imaging studies for HCC who did not undergo phlebotomy formed the control group. Patients were excluded from the control group if HCC developed within 1 year of initial AFP; or if there was concomitant hepatitis B or HIV infection, or if there was less than 3 years follow-up from initial AFP and patient did not develop HCC or decompensation. 9 patients were lost to follow up and so the control group comprised 101 patients with hepatitis C and AFP > 10 who did not undergo phlebotomy. Hepatoma was diagnosed based on histology or accepted clinical and imaging criteria. Decompensation was determined based on CTP score >7 or accepted clinical criteria.

Results: Baseline initial demographic and clinical characteristics of both groups are shown in Table 1. Phlebotomy patients were significantly older than control group and had more African American patients. CPT scores and FIB 4 scores were similar in both groups. 87/101 (86%) control patients were identified as progressors (developed hepatoma, or decompensated liver disease, or death, or had liver transplant) compared to 13/33 (39%) progressors in iron reduction patients (OR=0.10, CI 0.04-0.26, p < 0.0001) (Table 2&3). HCC was diagnosed in 33/101 (33%) control patients compared to 4/33 (12%) patients in iron reduction group. End of study CTP score was 8 in control group compared to CPT score of 5 in iron reduction group (p < 0.0001).

Conclusion: Long-term phlebotomy to maintain iron depletion can reduce AFP levels and reduce the risk of HCC and clinical decompensation and improve survival in advanced CHC with high AFP


American College of Gastroenterology (ACG) Annual Scientific Meeting, Orlando, FL, October 13-18, 2017.