Brief Article
Copyright ©2010 Baishideng. All rights reserved.
World J Gastroenterol. Feb 7, 2010; 16(5): 596-602
Published online Feb 7, 2010. doi: 10.3748/wjg.v16.i5.596
Phlebotomy improves histology in chronic hepatitis C males with mild iron overload
Emanuele Albano, Mario Del Piano, Stefania Carmagnola, Cristina Bozzola, Renzo Boldorini, Angelo Rossini, Silvano Andorno, Massimo Sartori
Massimo Sartori, Silvano Andorno, Stefania Carmagnola, Mario Del Piano, Gastroenterology Unit, Azienda Ospedaliero-Universitaria Maggiore della Carità, Corso Mazzini, 18, 28100 Novara, Italy
Angelo Rossini, Hepatology Unit, A.O. Spedali Civili, 25100 Brescia, Italy
Renzo Boldorini, Cristina Bozzola, Emanuele Albano, Department of Medical Sciences University of East Piedmont “Amedeo Avogadro”, 28100 Novara, Italy
Author contributions: Sartori M collected clinical data, and contributed to the study design and the writing of the manuscript; Andorno S performed statistical analysis; Rossini A collected clinical data and contributed to the study design; Carmagnola S collected clinical data; Boldorini R and Bozzola C performed histological analysis; Del Piano M contributed to the study design; Albano E supervised the work.
Correspondence to: Dr. Massimo Sartori, Gastroenterology Unit, Azienda Ospedaliero-Universitaria Maggiore della Carità, Corso Mazzini, 18, 28100 Novara, Italy. sartori@fauser.edu
Telephone: +39-321-3733206 Fax: +39-321-3733345
Received: September 5, 2009
Revised: November 4, 2009
Accepted: November 11, 2009
Published online: February 7, 2010
Abstract

AIM: To investigate the usefulness of mild iron depletion and the factors predictive for histological improvement following phlebotomy in Caucasians with chronic hepatitis C (CHC).

METHODS: We investigated 28 CHC Caucasians with persistently elevated serum aminotransferase levels and non responders to, or unsuitable for, antiviral therapy who underwent mild iron depletion (ferritin ≤ 70 ng/mL) by long-term phlebotomy. Histological improvement, as defined by at least one point reduction in the staging score or, in case of unchanged stage, as at least two points reduction in the grading score (Knodell), was evaluated in two subsequent liver biopsies (before and at the end of phlebotomy, 48 ± 16 mo apart).

RESULTS: Phlebotomy showed an excellent safety profile. Histological improvement occurred in 12/28 phlebotomized patients. Only males responded to phlebotomy. At univariate logistic analysis alcohol intake (P = 0.034), high histological grading (P = 0.01) and high hepatic iron concentration (HIC) (P = 0.04) before treatment were associated with histological improvement. Multivariate logistic analysis showed that in males high HIC was the only predictor of histological improvement following phlebotomy (OR = 1.41, 95% CI: 1.03-1.94, P = 0.031). Accordingly, 12 out of 17 (70%) patients with HIC ≥ 20 μmol/g showed histological improvements at the second biopsy.

CONCLUSION: Male CHC Caucasian non-responders to antiviral therapy with low-grade iron overload can benefit from mild iron depletion by long-term phlebotomy.

Keywords: Hepatic iron; Hepatitis C; Oxidative stress; Aminotransferases