title: Discordance between ALT values and fibrosis in liver transplant recipients treated with ribavirin for recurrent hepatitis C.
abstract: Hepatitis C virus (HCV) recurrence is a serious problem after orthotopic liver transplantation (OLT). The role of ribavirin as a single agent to treat recurrent HCV is controversial. Our aim was to evaluate the correlation between alanine aminotransferase (ALT) levels and histological findings in OLT recipients treated with ribavirin monotherapy for recurrent HCV. The mean [+/- standard error (SE)] age of 11 patients was 50.1 (SE +/- 8.6) years. The estimated mean dose and duration of ribavirin treatment (+/- SE) was 661.5 (+/- 52.5) mg and 20.4 (+/- 1.7) months, respectively. Five patients required either dose reduction or erythropoietin. We found a significant decrease of mean (+/- SE) ALT value from 246 +/- 44.8 U/L to 109.4 +/- 49.1 U/L (p = 0.002) in patients treated with ribavirin. However, there was also significant worsening of interface activity (p = 0.03) and fibrosis (p = 0.02). No significant association was found between ALT values and (i) stage of hepatic fibrosis, (ii) interface activity, (iii) lobular activity and (iv) HCV RNA values. Our results suggest that HCV disease can progress despite a significant decrease in ALT values. ALT values are inadequate markers of the ribavirin monotherapy and can lead to erroneous conclusions of efficacy.
authors.affiliation: Department of Medicine, Dumont-UCLA Liver Transplant Center, University of California Los Angeles, USA. Ssaab@mednet.ucla.edu
authors.forename: Sammy
authors.initials: S
authors.lastname: Saab
authors.forename: Rena
authors.initials: R
authors.lastname: Hu
authors.forename: Ayman B
authors.initials: AB
authors.lastname: Ibrahim
authors.forename: Leonard I
authors.initials: LI
authors.lastname: Goldstein
authors.forename: Gregg
authors.initials: G
authors.lastname: Kunder
authors.forename: Francisco
authors.initials: F
authors.lastname: Durazo
authors.forename: Steven
authors.initials: S
authors.lastname: Han
authors.forename: Hasan
authors.initials: H
authors.lastname: Yersiz
authors.forename: Rafik M
authors.initials: RM
authors.lastname: Ghobrial
authors.forename: Douglas G
authors.initials: DG
authors.lastname: Farmer
authors.forename: Ronald W
authors.initials: RW
authors.lastname: Busuttil
authors.forename: Charles
authors.initials: C
authors.lastname: Lassman
mesh_terms: D000328:Adult; D000368:Aged; D000410:Alanine Transaminase / Q000097:blood*; D000998:Antiviral Agents / Q000494:pharmacology; D004921:Erythropoietin / Q000494:pharmacology; D005260:Female; D005355:Fibrosis / Q000175:diagnosis*; D016174:Hepacivirus; D006526:Hepatitis C / Q000188:drug therapy*; D006801:Humans; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D012254:Ribavirin / Q000627:therapeutic use*; D013997:Time Factors
chemical_list: D000998:Antiviral Agents; D004921:Erythropoietin; D012254:Ribavirin; D000410:Alanine Transaminase