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Hepatitis C Recurrence After Liver Transplantation: Viral and Histologic Response to Full‐Dose Peg‐Interferon and Ribavirin
Author(s) -
Oton E.,
Barcena R.,
MorenoPlanas J. M.,
CuervasMons V.,
MorenoZamora A.,
Barrios C.,
GarciaGarzon S.,
Moreno A.,
BoullosaGraña E.,
RubioGonzalez E. E.,
GarciaGonzalez M.,
Blesa C.,
Mateos M. L.
Publication year - 2006
Publication title -
american journal of transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.89
H-Index - 188
eISSN - 1600-6143
pISSN - 1600-6135
DOI - 10.1111/j.1600-6143.2006.01470.x
Subject(s) - medicine , ribavirin , gastroenterology , cirrhosis , hepatitis c , neutropenia , hepatitis c virus , liver transplantation , transplantation , viral load , surgery , immunology , toxicity , virus
Hepatitis C recurrence after liver transplantation (LT) is universal, and frequently leads to cirrhosis and death. The aim of our study was to assess the efficacy and safety of 48‐weeks of full‐dose peg‐interferon‐α‐2a (n = 4) or α‐2b (n = 51) plus ribavirin (>11 mg/kg/day) in a multicentric cohort of 55 patients ≥12 months after LT. All subjects had histologically proven HCV recurrence, excluding severe cholestatic recurrence. Mean age was 54.3 ± 9.7, 77% male, 90.9% genotype 1, 32.7% cirrhotics. All but 5 patients received monotherapy with tacrolimus (54.5%), cyclosporine (30.7%) or mycophenolate mofetil (5.5%). The rates of end‐of‐treatment response and sustained virological response (SVR) were 66.7% and 43.6%, respectively. Low baseline HCV‐RNA (p = 0.005) and a length from LT to therapy between 2–4 years (p = 0.011) were predictors of SVR. The lack of achieving a viral load decrease ≥1‐log 10 at week 4 and/or 2‐log 10 at week 12 was 100% predictive of failure. The most frequent side effects were neutropenia (76,4%), anemia (60%) and infectious complications (30.9%). Toxicity led to peg‐interferon withdrawal in 16 (29%) subjects. In 15 patients with post‐treatment biopsy, the histological activity index was significantly improved (p = 0.006), whereas fibrosis did not change (p = 0.14). Three patients died (cholangitis, hepatic artery thrombosis and lung cancer). In conclusion, HCV therapy after LT was very effective, although it led to a significant rate of toxicity.