Impact of pegylated interferon alfa-2a and ribavirin on hepatic fibrosis in liver transplant patients with recurrent hepatitis C: an open-label series.
OBJECTIVE
Patients with recurrent hepatitis C are often treated with interferon-based therapy in an attempt to prevent cirrhosis requiring retransplantation. We describe our experience with 32 patients with recurrent HCV.


METHODS
Patients were followed prospectively after starting pegylated interferon alfa-2a 180 microg per week and ribavirin 1000-1200mg per day. HCV ribonucleic acid (HCVRNA) was repeated at three months, end of treatment (EOT) and six months after EOT for patients HCVRNA negative at EOT.


RESULTS
There were 22 males and 10 females. 21 patients have completed treatment, six remain on therapy and five were intolerant. In an intention-to-treat analysis, sustained viral eradication occurred in 40.6% of patients. Fibrosis scores were worse in eight patients of whom six were sustained responders. Three of these patients developed decompensated liver disease. Two were successfully retransplanted and remain HCVRNA negative after a mean follow-up of 11 months.


CONCLUSIONS
Pegylated interferon alpha-2a and ribavirin were well tolerated in this small series. Sustained HCV eradication occurred in at least 40.6% of patients but progressive fibrosis occurred in 75% of sustained responders. This suggests that mechanisms other than recurrent HCV may be responsible for cirrhosis in sustained responders who remain at risk of developing decompensated liver disease.
Mukherjee
Sandeep
S
Section of Gastroenterology and Hepatology, Nebraska Medical Center, Omaha, 68198-3283, USA. smukherj@unmc.edu
Lyden
Elizabeth
E
D000293:Adolescent; D000328:Adult; D000998:Antiviral Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D004359:Drug Therapy, Combination; D005260:Female; D016174:Hepacivirus / Q000187:drug effects; D006526:Hepatitis C / Q000150:complications / Q000188:drug therapy* / Q000821:virology; D006801:Humans; D000077190:Interferon alpha-2; D016898:Interferon-alpha / Q000008:administration & dosage / Q000627:therapeutic use*; D008103:Liver Cirrhosis / Q000188:drug therapy* / Q000209:etiology / Q000517:prevention & control / Q000821:virology*; D016031:Liver Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D011092:Polyethylene Glycols / Q000008:administration & dosage / Q000627:therapeutic use*; D011994:Recombinant Proteins; D012008:Recurrence; D012254:Ribavirin / Q000008:administration & dosage / Q000627:therapeutic use*; D016896:Treatment Outcome
D000998:Antiviral Agents; D000077190:Interferon alpha-2; D016898:Interferon-alpha; D011994:Recombinant Proteins; D011092:Polyethylene Glycols; D012254:Ribavirin; C100416:peginterferon alfa-2a