Outcomes of acute rejection after interferon therapy in liver transplant recipients.
Interferon alfa has been increasingly used against recurrent hepatitis C (HCV) disease in post-liver transplant (LT) recipients. A serious potential adverse effect is acute rejection. We reviewed our experience using interferon-based therapy (interferon or pegylated interferon with or without ribavirin) for treating recurrent HCV in LT recipients. Forty-four LT recipients were treated with interferon for recurrent HCV. Five of the 44 patients developed acute rejection during interferon-based therapy. These 5 patients started treatment of 42.4 +/- 33.89 months (mean +/- SD) after LT. Mean (+/- SD) histological activity index and fibrosis scores before initiating antiviral therapy were 8.8 (+/- 1.92) and 2.6 (+/- 0.55), respectively. Patients were treated for 3.3 +/- 2.28 months (mean +/- SD) prior to rejection. At the time of rejection, HCV load was not detectable in 4 of the 5 recipients. All 5 patients had tolerated interferon therapy, and none had stopped therapy because of adverse effects. The rejection was successfully treated in 3 patients. In 2 of those 3 patients, cirrhosis eventually developed. In the 2 patients who did not respond to rejection treatment, immediate graft failure occurred, leading to re-LT in 1 patient and death from sepsis in the other. In conclusion, the results indicate that further studies are needed to assess the safety of interferon in LT recipients. Interferon-based therapy may lead to acute rejection and subsequent graft loss and should therefore be used with caution. Treated recipients may also develop progressive cirrhosis despite achieving a sustained virological response.
Saab
Sammy
S
Department of Medicine, Dumont-UCLA Liver Transplant Center, Los Angeles, CA, USA. SSaab@mednet.ucla.edu
Kalmaz
Denise
D
Gajjar
Nupoor A
NA
Hiatt
Jonathan
J
Durazo
Francisco
F
Han
Steven
S
Farmer
Douglas G
DG
Ghobrial
R Mark
RM
Yersiz
Hasan
H
Goldstein
Leonard I
LI
Lassman
Charles R
CR
Busuttil
Ronald W
RW
D000328:Adult; D000998:Antiviral Agents / Q000627:therapeutic use*; D005260:Female; D006084:Graft Rejection / Q000401:mortality / Q000628:therapy*; D006526:Hepatitis C / Q000188:drug therapy* / Q000601:surgery*; D006801:Humans; D007372:Interferons / Q000627:therapeutic use*; D016031:Liver Transplantation / Q000276:immunology* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D012189:Retrospective Studies; D012254:Ribavirin / Q000627:therapeutic use; D016896:Treatment Outcome
D000998:Antiviral Agents; D012254:Ribavirin; D007372:Interferons