Hepatitis C Recurrence After Liver Transplantation: Viral and Histologic Response to Full-Dose Peg-Interferon and Ribavirin

Abstract

Hepatitis C recurrence after liver transplantation (LT) is universal, and frequently leads to cirrhosis and death. The aim of our study was to assess the efficacy and safety of 48-weeks of full-dose peg-interferon-a-2a (n = 4) or a -2b (n = 51) plus ribavirin (>11 mg/kg/day) in a multicentric cohort of 55 patients ≥12 months after LT. All subjects had histologically proven HCV recurrence, excluding severe cholestatic recurrence. Mean age was 54.3 ± 9.7, 77% male, 90.9% genotype 1, 32.7% cirrhotics. All but 5 patients received monotherapy with tacrolimus (54.5%), cyclosporine (30.7%) or mycophenolate mofetil (5.5%). The rates of end-of-treatment response and sustained virological response (SVR) were 66.7% and 43.6%, respectively. Low baseline HCV-RNA (p = 0.005) and a length from LT to therapy between 2-4 years (p = 0.011) were predictors of SVR. The lack of achieving a viral load decrease ≥1-log 10 at week 4 and/or 2-log 10 at week 12 was 100% predictive of failure. The most frequent side effects were neutropenia (76,4%), anemia (60%) and infectious complications (30.9%). Toxicity led to peg-interferon withdrawal in 16 (29%) subjects. In 15 patients with post-treatment biopsy, the histological activity index was significantly improved (p = 0.006), whereas fibrosis did not change (p = 0.14). Three patients died (cholangitis, hepatic artery thrombosis and lung cancer). In conclusion, HCV therapy after LT was very effective, although it led to a significant rate of toxicity.

Recurrent hepatitis C after liver transplantation: On-treatment prediction of response to peginterferon/ribavirin therapy

“…[5][6][7] The lower rate of SVR compared to nontransplant HCV patients can be attributed to several factors including differences in the HCV dynamics between the immunocompetent and immunocompromised hosts, 20,21 higher prevalence of insulin resistance in LT recipients, and lower tolerability of PEG/RBV. 22,23 Consistent with the treatment of chronic nontransplantation HCV infection, genotypes other than 1 were associated with a significantly higher rate of SVR. Similarly, a strong statistical trend was observed toward a higher SVR in LT patients with low pretreatment HCV RNA.…”

Hepatitis C and Liver Transplantation

“…The optimal dose and duration of antiviral treatment in transplant patients are unknown, and the same regimens are usually followed as those applied to immunocompetent patients (Otón et al, 2006).…”

Managing hepatitis C in liver transplant patients with recurrent infection

“…[93][94][95][96]98,99,102,105,106,109,110,127,145,146 Most published studies are uncontrolled trials with a high variability in patient selection, and type and timing of antiviral therapy. Rates of SVR have been less than those achieved in the nontransplant setting.…”