title: Treatment of established recurrent hepatitis C in liver-transplant recipients with pegylated interferon-alfa-2b and ribavirin therapy.
abstract: BACKGROUND
  The management issues of transplant patients with hepatitis C virus (HCV) are complex, and interferon therapy is often ineffective. We present data from a retrospective review in liver-transplant recipients suffering from HCV recurrence that were treated with pegylated alpha-2b interferon and ribavirin.
  
  
  METHODS
  A retrospective review of transplant recipients that received combination pegylated alpha-2b interferon (1.5 mcg/kg/wk) and ribavirin (400-600 mg/day) therapy intended for at least 48 weeks. Complications were recorded and included neutropenia (<750 cells), anemia (hemoglobin <8 g) with and without treatment consisting of blood transfusions, erythropoietin, or dose reduction of ribavirin, and depression. The diagnosis of HCV recurrence was determined by an increase in liver chemistries, histopathologic findings with inflammation along with viral recurrence using the COBAS AMPLICOR HCV test.
  
  
  RESULTS
  Fifty-seven liver-transplant recipients were included, 29 naive (group 1) to therapy and 28 nonresponders (group 2) to at least 6 months of interferon and ribavirin therapy. Eight (27.6%) patients in group 1 and six (21%) patients in group 2 were HCV nondetectable at the end of 48 weeks of therapy. Ribavirin therapy was decreased in 13 of 29 (45%) for group 1 and 11 of 28 (39%) in group 2. Therapeutic interventions were 4 of 57 (7%) blood transfusions, 23 of 57 (40%) erythropoietin, and 17 of 57 (30%) filgrastim.
  
  
  CONCLUSIONS
  Combination pegylated interferon with ribavirin appears to effective therapy in HCV recurrence and in HCV nonresponsive to interferon and ribavirin. This data reveals the difficulty and caution that must be taken when treating HCV-R liver-transplant recipients with combination pegylated alpha-2b interferon and ribavirin therapy.
authors.affiliation: Center for Liver Diseases, Division of GI Transplant, Department of Medicine, University of Miami, Miami, FL, USA. guy.neff@uc.edu
authors.forename: Guy W
authors.initials: GW
authors.lastname: Neff
authors.forename: Marzia
authors.initials: M
authors.lastname: Montalbano
authors.forename: Christopher B
authors.initials: CB
authors.lastname: O'Brien
authors.forename: Seigo
authors.initials: S
authors.lastname: Nishida
authors.forename: Kamran
authors.initials: K
authors.lastname: Safdar
authors.forename: Pablo A
authors.initials: PA
authors.lastname: Bejarano
authors.forename: Amr S
authors.initials: AS
authors.lastname: Khaled
authors.forename: Phillip
authors.initials: P
authors.lastname: Ruiz
authors.forename: Gabriella
authors.initials: G
authors.lastname: Slapak-Green
authors.forename: Mei
authors.initials: M
authors.lastname: Lee
authors.forename: Jose
authors.initials: J
authors.lastname: Nery
authors.forename: Maria
authors.initials: M
authors.lastname: De Medina
authors.forename: Andreas
authors.initials: A
authors.lastname: Tzakis
authors.forename: Eugene R
authors.initials: ER
authors.lastname: Schiff
mesh_terms: D000328:Adult; D000368:Aged; D004359:Drug Therapy, Combination; D005260:Female; D006526:Hepatitis C / Q000188:drug therapy*; D006801:Humans; D000077190:Interferon alpha-2; D016898:Interferon-alpha / Q000008:administration & dosage*; D016031:Liver Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D011092:Polyethylene Glycols; D011994:Recombinant Proteins; D012008:Recurrence; D012189:Retrospective Studies; D012254:Ribavirin / Q000008:administration & dosage*
chemical_list: D000077190:Interferon alpha-2; D016898:Interferon-alpha; D011994:Recombinant Proteins; D011092:Polyethylene Glycols; D012254:Ribavirin; C417083:peginterferon alfa-2b