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Open Access Research article

Effect of laparoscopic splenectomy in patients with Hepatitis C and cirrhosis carrying IL28B minor genotype

Takashi Motomura1, Ken Shirabe1*, Norihiro Furusyo2, Tomoharu Yoshizumi1, Toru Ikegami1, Yuji Soejima1, Tomohiko Akahoshi1, Morimasa Tomikawa1, Takasuke Fukuhara3, Jun Hayashi2 and Yoshihiko Maehara1

Author Affiliations

1 Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, 812-8582, Japan

2 Department of General Internal Medicine, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan

3 Department of Molecular Virology, Research Institute for Microbial Diseases, Osaka University, Osaka, Japan

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BMC Gastroenterology 2012, 12:158  doi:10.1186/1471-230X-12-158

Published: 12 November 2012

Abstract

Background

IL28B and ITPA genetic variants are associated with the outcome of pegylated-interferon and ribavirin (PEG-IFN/RBV) therapy. However, the significance of these genetic variants in cirrhotic patients following splenectomy has not been determined.

Methods

Thirty-seven patients with HCV-induced cirrhosis who underwent laparoscopic splenectomy (Spx group) and 90 who did not (non-Spx group) were genotyped for IL28B and ITPA. The outcome or adverse effects were compared in each group. Interferon-stimulated gene 15 (ISG15) and protein kinase R expression in the spleen was measured using total RNA extracted from exenterate spleen.

Results

Sustained virological response (SVR) rate was higher in patients carrying IL28B major genotype following splenectomy (50% vs 27.3%) and in patients carrying minor genotype in the Spx group compared to non-Spx group (27.3% vs 3.6%, P < 0.05). Pretreatment splenic ISG expression was higher in patients carrying IL28B major. There was no difference in progression of anemia or thrombocytopenia between patients carrying each ITPA genotype in the Spx group. Although splenectomy did not increase hemoglobin (Hb) level, Hb decline tended to be greater in the non-Spx group. In contrast, splenectomy significantly increased platelet count (61.1 × 103/μl vs 168.7 × 103/μl, P < 0.01), which was maintained during the course of PEG-IFN/RBV therapy.

Conclusions

IL28B genetic variants correlated with response to PEG-IFN/RBV following splenectomy. Splenectomy improved SVR rate among patients carrying IL28B minor genotype and protected against anemia and thrombocytopenia during the course of PEG-IFN/RBV therapy regardless of ITPA genotype.

Keywords:
IL28B; ITPA; Splenectomy; Liver cirrhosis