Hepatitis C recurrence after liver transplantation is universal, and frequently leads to cirrhosis and death.
Dr Barcena and colleagues from Madrid assessed the efficacy and safety peg-interferon-α-2a or α-2b plus ribavirin after liver transplantation.
The research team evaluated a multicentric cohort of 55 patients 12 or more months after liver transplantation receiving intervention for 48 weeks.
All subjects had histologically proven Hepatitis C recurrence, excluding severe cholestatic recurrence.
The patients' mean age was 54 years, and 77% male with 91% presenting with genotype 1, and 33% were cirrhotics.
|Neutropenia occurred in 76%, and anemia in 60%|
|American Journal of Transplantation|
All but 5 patients received monotherapy with tacrolimus, cyclosporine or mycophenolate mofetil.
The team found that the rates of end-of-treatment response and sustained virological response were 67% and 44%, respectively.
Low baseline Hepatitis C-RNA and a length from liver transplantation to therapy between 2 and 4 years were predictors of sustained virological response.
The team noted that lack of achieving a viral load decrease of 1-log10 at week 4 and/or 2-log10 at week 12 was 100% predictive of failure.
The researchers observed that side effects including neutropenia occurred in 76%, anemia in 60%, and infectious complications in 31%.
Toxicity led to peg-interferon withdrawal in 29% of subjects.
The team found that in 15 patients with post-treatment biopsy, the histological activity index was significantly improved.
However, fibrosis did not change in these patients.
The researchers reported that 3 patients died of cholangitis, hepatic artery thrombosis and lung cancer.
Dr Barcena's team concludes, “Hepatitis C therapy after liver transplantation was very effective, although it led to a significant rate of toxicity.”