Phlebotomy may delay progression of liver fibrosis in chronic hepatitis C patients

NEW YORK (Reuters Health) – The use of phlebotomy to reduce iron levels in patients with chronic hepatitis C appears to delay the progression of liver fibrosis, according to a recent report by Japanese investigators.

The accumulation of iron in the liver that is observed in patients with chronic hepatitis C has been associated with elevated serum aminotransferase (ALT) levels and liver fibrosis. Although phlebotomy to reduce iron levels in these patients leads to decreased serum ALT, it is unclear if phlebotomy produces long-term beneficial effects.

Dr. Motoyoshi Yano, from Nagoya University, and colleagues assessed the outcomes of 25 chronic hepatitis C patients who underwent phlebotomy to achieve and maintain iron levels of 10 ng/mL or less over a 5-year period. Thirteen additional patients who were virologic nonresponders to interferon therapy alone and had underwent liver biopsies served as a histologic control group.

The initial phlebotomy session produced a significant reduction in serum ALT levels and these levels were maintained with subsequent sessions (p < 0.05), the investigators note in the January issue of The American Journal of Gastroenterology.

At 5-year follow-up, histologic grading scores had improved significantly in the phlebotomy group, but were unchanged in the control group (p < 0.05). Staging scores worsened in the control group, but remained stable in the phlebotomy group (p < 0.005). Furthermore, disease progression was significantly slower in the phlebotomy group (p < 0.05).

The current findings suggest that "maintenance of the iron-deficient state has beneficial effects in preventing disease progression in chronic hepatitis C patients," the authors state. Such therapy may be particularly useful in patients with elevated viral levels despite treatment with interferon alone or in combination with ribavirin. However, a prospective controlled study is needed to confirm the present results.

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