title: Maintenance ribavirin monotherapy delays fibrosis progression in liver transplant recipients with recurrent hepatitis C at high risk of progression.
abstract: BACKGROUND
  Fibrosis in liver transplant recipients with recurrent HCV is fast, yet, different patterns of progression are recognized.
  
  
  OBJECTIVE
  To investigate histological findings associated with maintenance ribavirin monotherapy in patients with recurrent HCV transplanted > or =4 years earlier.
  
  
  METHODS
  14 recipients at high risk of progression (fibrosis progression rate >0.33 units/year and/or persistently elevated ALT) were assigned to receive ribavirin for 3 years. 11 patients at lower risk of progression (FPR < or =0.33 units/year and normal ALT) as controls. Biopsies were obtained yearly since transplant and 7 consecutive biopsies were evaluated.
  
  
  RESULTS
  Improved necroinflammation (reduction > or =2 grading) was observed in 7 treated with ribavirin and 3 untreated patients, while 1 and 3 patients worsened respectively. Fibrosis improved (reduction >1 staging) in 2 ribavirin-treated patients, unchanged in 10 and worsened (increase > or =1 staging) in 2. Fibrosis progression decreased from 0.48+/-0.27 observed during the 3-year pre-treatment period to 0.04+/-0.31 units/year (p=0.003) during the 3 years of ribavirin. Among untreated fibrosis remained unchanged in 1 and worsened in 10 (p<0.001), yearly fibrosis progression rate increasing from 0.15+/-0.17 units/year to 0.42+/-0.39 units/year (p=0.10).
  
  
  CONCLUSIONS
  Maintenance ribavirin monotherapy delays fibrosis progression in high risk patients, offering an alternative strategy for those failing to respond to conventional treatment.
authors.affiliation: Hepatology Unit, University of Rome Tor Vergata, Via Montpellier 1, Rome, Italy.
authors.forename: Raffaella
authors.initials: R
authors.lastname: Lionetti
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Tisone
authors.forename: Giampiero
authors.initials: G
authors.lastname: Palmieri
authors.forename: Cristiana
authors.initials: C
authors.lastname: Almerighi
authors.forename: Alessandra
authors.initials: A
authors.lastname: Anselmo
authors.forename: Laura
authors.initials: L
authors.lastname: Tariciotti
authors.forename: Ilaria
authors.initials: I
authors.lastname: Lenci
authors.forename: Linda
authors.initials: L
authors.lastname: De Luca
authors.forename: Andrea
authors.initials: A
authors.lastname: Monaco
authors.forename: Mario
authors.initials: M
authors.lastname: Angelico
mesh_terms: D000998:Antiviral Agents / Q000008:administration & dosage*; D018450:Disease Progression; D005260:Female; D019698:Hepatitis C, Chronic / Q000188:drug therapy* / Q000473:pathology; D006801:Humans; D008103:Liver Cirrhosis / Q000188:drug therapy* / Q000473:pathology; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D011446:Prospective Studies; D012008:Recurrence; D012254:Ribavirin / Q000008:administration & dosage*
chemical_list: D000998:Antiviral Agents; D012254:Ribavirin