Flexible and individualized treatment to achieve sustained viral response for recurrent hepatitis C in liver transplant recipients

Abstract

Hepatitis C recurrence after liver transplantation is universal and is a major cause of long-term graft failure. Improving the effectiveness of recurrent hepatitis C treatment is extremely important. We studied 35 anti-hepatitis C virus (HCV)-positive patients who underwent liver transplantation. Among the 35 patients, 25 patients had recurrent hepatitis C and received antiviral treatment. HCV RNA load after liver transplantation was increased by 3.68-fold. The antiviral treatment regimen comprised pegylated-interferon (180 μg) every 2 weeks and ribavirin at a dose of 200-400 mg every day. The treatment duration was flexible and individualized, and depended on viral response to treatment. The dosage of tacrolimus was decreased gradually to minimize immunocompromise. Median (interquartile) serum level of tacrolimus was 6.9 (6-8.9) ng/mL at initiation of treatment and 3.8 (3.6-5) ng/mL at the end of treatment. One patient (4.0%) was withdrawn from the study, and three patients (12%) died of infection during treatment. At end of treatment, 18 of 25 patients (72%) were negative for serum HCV RNA. After an additional 6 months following the end of treatment, 16 of the 25 patients (64%) had sustained viral response (SVR) and only two patients had HCV relapse. The 1-year, 3-year and 5-year survival rates were 91.4%, 84.5% and 84.5% for all patients and 88.0%, 82.8% and 82.8% for the 25 patients who received antiviral therapy. In conclusion, recurrent HCV infection is an important issue in liver transplantation. The flexible regimen of antiviral therapy and individualized immunosuppressive agents that was applied in this study achieved a SVR rate of 64%.

Spanish society of liver transplantation (SETH) consensus recommendations on hepatitis C virus and liver transplantation

“…Most available data come from uncontrolled studies with different designs regarding time to start treatment, regime used and follow‐up. Therefore, the results are also very different, with SVR rates ranging between 20% and 50% with an average around 30% . These results are lower than those obtained in non‐transplanted patients, possibly because of the immunosuppressive status, the high prevalence of HCV genotype 1‐infected patients, the typical high viral load and the difficulty in maintaining adequate antiviral doses, especially RBV, and maintaining therapy for the ideal duration.…”

Antiviral Treatment for Hepatitis C Virus Infection after Liver Transplantation

“…The 19 reviewed studies showed a mean end-of-treatment response of 42% and a mean overall SVR of 30%. A recent study [ 122 ] disclosed an SVR rate of 64% in DDLT patients. The antiviral treatment regimen comprised pegylated-IFN (180 μ g) every 2 weeks and RBV at a dose of 200 to 400 mg every day.…”