H Hayashi, S Wakusawa, T Takikawa, N Arai, M Yano*, S Kato{**}, M Arao{**} Dept. of Med., Hokuriku Univ., *Third Dept. of Int. Med., Nagoya Univ. and {**}Dept. of Med., Inazawa City Hospital, Japan

Phlebotomy with a 10 ng/ml end point for the serum ferritin level reduces liver enzymes in patients with chronic hepatitis C (CHC). Here we report the long-term effects of iron removal on patients, including histological changes and complication by hepatocellular carcinoma. Thirty patients who had reached the end point of inital phlebotomy were followed for more than 3 years and given maintenance phlebotomy, if needed, to maintain the iron depleted state. Ursodeoxycholic acid or azathioprine was permitted with our dosage change throughout the study period. Twenty-three patients received non-effective interferon treatment within a year after reaching the end point.

Initial phlebotomy significantly reduced serum levels of ALT and maintenance phlebotomy stablized the improved liver function test for the study period (Table). There was no effect on circulating HCV RNA.

                          ALT (U/l) hemoglobin(g/dl)  ferritin(ng/ml)
     pretreatment(n=30)  124±68      14.0±1.4          204±180
     posttreatment(n=30)  76±38      11.4±1.4            8±2
     3 years(n=30)        67±33      11.8±1.5           15±15
     4 years(n=11)        58±27      12.4±1.9            11±5

Serum ALT levels 3 and 4 years posttreatment remained significantly lower than the pretreatment level.

Histology of biopsied livers remained the same in 4 patients and progressed in one patient from CAH 2A to 2B. Hepatocellular carcinomas, all less than 20 mm in diameter, developed in 5 patients. Two patients were successfully treated by hepatectomy, 3 by transarterial embolization. None of the patients died during the study period.

These data indicate that iron removal from CHC patients is effective for at least 4 years, if combined with maintenance phlebotomy. Long-term biochemical improvement may be associated with a slower progression in liver histology. The effect of iron removal on malignant change should be further investigated, since iron deficiency is considered unfavorable for malignant growth.

Source: American Association for the Study of Liver Diseases - 1996 Annual Meeting

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