Treatment of recurrent hepatitis C after liver transplantation: a pilot study of peginterferon alfa-2b and ribavirin combination.
OBJECTIVE
After liver transplantation (LT) for HCV-related cirrhosis, recurrence of HCV infection is universal and the risk of progression to cirrhosis is high. The modalities and efficacy of antiviral therapy in this indication are still controversial. We present here the results of a pilot study of a 12-month combination therapy by pegylated alfa 2b-interferon (PEG-IFN) and ribavirin in 20 patients.


METHODS
Twenty patients entered the study (13 male and 7 female, median age 53.8 years). In 80% of patients, HCV infection was of genotype 1. The delay between LT and antiviral therapy was 28 months. The doses were progressively increased from 0.5 to 1 micro g/kg/week for PEG-IFN and from 400 to 1000-1200 mg/d for ribavirin. Follow-up was based on biochemical (ALT), virological (HCV-RNA) and histological (liver biopsy) examinations.


RESULTS
Four patients (20%) were withdrawn due to adverse effects. In 6 patients the dose of PEG-IFN had to be reduced to 0.5 micro g/kg/week. A reduction in the dose of ribavirin in 13/16 cases was due to the onset of anemia. Histological evidence of mild acute rejection increased the immunosuppressive regimen in 5/20 patients. At the end of the treatment, 75% of the patients had a biochemical response and 55% a virological response. The mean METAVIR score, according to activity and fibrosis, was A1.8 F2.2 before treatment and A0.3 F1.6 at the end of treatment. In 9/20 patients, virological response persisted 6 months after the end of the treatment.


CONCLUSIONS
Our results suggest that combination therapy by PEG-IFN and ribavirin may be well tolerated and beneficial during recurrent hepatitis C in liver transplant recipients.
Dumortier
Jérôme
J
Unité de transplantation hépatique-Fédération des Spécialités Digestives, Hôpital Edouard Herriot, 69437 Lyon Cedex 03, France. jerome.dumortier@chu-lyon.fr
Scoazec
Jean-Yves
JY
Chevallier
Philippe
P
Boillot
Olivier
O
D000328:Adult; D000368:Aged; D000998:Antiviral Agents / Q000008:administration & dosage* / Q000009:adverse effects; D004359:Drug Therapy, Combination; D004361:Drug Tolerance; D005260:Female; D019698:Hepatitis C, Chronic / Q000188:drug therapy* / Q000209:etiology* / Q000601:surgery; D006801:Humans; D000077190:Interferon alpha-2; D016898:Interferon-alpha / Q000008:administration & dosage* / Q000009:adverse effects; D008103:Liver Cirrhosis / Q000209:etiology / Q000601:surgery; D016031:Liver Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D011092:Polyethylene Glycols; D011994:Recombinant Proteins; D012008:Recurrence; D012254:Ribavirin / Q000008:administration & dosage* / Q000009:adverse effects
D000998:Antiviral Agents; D000077190:Interferon alpha-2; D016898:Interferon-alpha; D011994:Recombinant Proteins; D011092:Polyethylene Glycols; D012254:Ribavirin; C417083:peginterferon alfa-2b