Recurrence of Hepatitis C virus infection after orthotopic liver transplantation is a virtually universal occurrence.
A significant proportion of patients develop chronic Hepatitis and cirrhosis.
Dr Süleyman Yedibela and colleagues from Germany evaluated the safety and efficacy of interferon-2b plus ribavirin.
| After 3 months, 73% of patients were free from Hepatitis C virus RNA|
The researchers assessed the efficacy of this combination therapy in the treatment of recurrent Hepatitis C after othotopic liver transplantation over the long term.
The research team started 15 patients with recurrent Hepatitis C infection on interferon-2b plus ribavirin 18 months after orthotopic liver transplantation.
Interferon-2b was given as 36 million units and administered subcutaneously 3 times a week, whilst ribavirin was administered at 800 to 1200 mg/day.
The team defined recurrent Hepatitis C infection where there was positive serum Hepatitis C RNA, elevated serum aminotransferases, and histological activity.
Hepatitis C virus RNA was determined 1, 3, 6, 9, 12 and 18 months after initiation of treatment.
The researchers performed liver biopsy before and after therapy and followed up the patients for a mean of 33 months.
The team found that 87% of patients were treated for at least 6 months and 60% for 12 months.
After 3 months, the team noted that 73% were free from Hepatitis C RNA, with less than 50 copies/ml, and that virological end-of-treatment response was 67%.
The researchers observed that 33% remained Hepatitis C RNA-negative 6 months posttreatment.
During the follow-up period, 27% died of liver failure, recurrent Hepatitis C after virological response, or hepatocellular carcinoma.
The researchers found that histological activity index improved significantly for both inflammatory activity and fibrosis, from 9 to 5 and from 7 to 5, respectively.
In none of the patients signs of rejection were observed.
Dr Yedibela's team concludes, “Combination therapy with interferon and ribavirin in transplanted patients with chronic Hepatitis C is an effective treatment that results in a high virological SR rate.”
“It is well tolerated and leads to an improvement in histological outcome.”