title: Treatment of recurrent hepatitis C infection after liver transplantation with combination of pegylated interferon alpha2b and ribavirin: an open-label series.
abstract: BACKGROUND
  Hepatitis C virus (HCV) recurrence after orthotopic liver transplantation (OLT) is universal. We aimed to evaluate the efficacy and safety of pegylated interferon (PEG-IFN) and ribavirin (RIB) in the treatment of post-OLT HCV recurrence.
  
  
  METHODS
  Thirty-seven patients with recurrent HCV after OLT were screened and began treatment. Nineteen patients have completed therapy. PEG-IFN was started at a dose of 0.5 microg/kg per week and titrated toward a maximum dose of 1.5 microg/kg per week. RIB was started at a dose of 400 mg per day and titrated toward a maximum of 1000 mg per day, as tolerated. Therapy continued for 1 year after HCV replication was undetectable by reverse transcriptase-polymerase chain reaction and was discontinued if there was no virologic clearance at 48 weeks.
  
  
  RESULTS
  Twelve patients (63%) completed the combination regimen. Therapy was discontinued in seven (37%) patients. Seven patients (37%) had undetectable viral load at the end of treatment. Of those, five patients (26%) had sustained viral response 6 months after discontinuation of therapy. Five patients (26%) had no virologic response. Necro-inflammatory score declined from 5.22 to 2.89 (P=0.05) in nonresponders versus 6.8 to 2.6 (P<0.01) in responders. Fibrosis stage did not change in either group. Genotype 1-infected patients had a lower likelihood of attaining end of treatment or sustained viral response (P<0.05 for both).
  
  
  CONCLUSIONS
  Post-OLT HCV recurrence can be safely treated with PEG-IFN and RIB. Bone marrow toxicity, depression, and rejection are limiting factors that require aggressive management. There was short-term histologic benefit to the use of this regimen, even in those patients without viral clearance.
authors.affiliation: Division of Transplantation Medicine, Mayo Clinic, Scottsdale, AZ.
authors.forename: Hector
authors.initials: H
authors.lastname: Rodriguez-Luna
authors.forename: Amer
authors.initials: A
authors.lastname: Khatib
authors.forename: Pratima
authors.initials: P
authors.lastname: Sharma
authors.forename: Giovanni
authors.initials: G
authors.lastname: De Petris
authors.forename: James W
authors.initials: JW
authors.lastname: Williams
authors.forename: Jose
authors.initials: J
authors.lastname: Ortiz
authors.forename: Kathleen
authors.initials: K
authors.lastname: Hansen
authors.forename: David
authors.initials: D
authors.lastname: Mulligan
authors.forename: Adyr
authors.initials: A
authors.lastname: Moss
authors.forename: David D
authors.initials: DD
authors.lastname: Douglas
authors.forename: Vijayan
authors.initials: V
authors.lastname: Balan
authors.forename: Jorge
authors.initials: J
authors.lastname: Rakela
authors.forename: Hugo E
authors.initials: HE
authors.lastname: Vargas
mesh_terms: D000998:Antiviral Agents / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D005260:Female; D016174:Hepacivirus / Q000235:genetics / Q000302:isolation & purification; D006526:Hepatitis C / Q000188:drug therapy*; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D000077190:Interferon alpha-2; D016898:Interferon-alpha / Q000627:therapeutic use*; D008111:Liver Function Tests; D016031:Liver Transplantation / Q000502:physiology*; D008297:Male; D008875:Middle Aged; D011092:Polyethylene Glycols / Q000627:therapeutic use*; D012367:RNA, Viral / Q000302:isolation & purification; D011994:Recombinant Proteins; D012008:Recurrence; D020133:Reverse Transcriptase Polymerase Chain Reaction; D012254:Ribavirin / Q000627:therapeutic use*; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000998:Antiviral Agents; D007166:Immunosuppressive Agents; D000077190:Interferon alpha-2; D016898:Interferon-alpha; D012367:RNA, Viral; D011994:Recombinant Proteins; D011092:Polyethylene Glycols; D012254:Ribavirin; C100416:peginterferon alfa-2a