There is currently no effective treatment for recurrent hepatitis C after orthotopic liver transplantation (OLT).
Dr Chalasani and colleagues performed 2 randomized, controlled trials - a prophylaxis trial and a treatment trial – in order to evaluate the safety and efficacy of peginterferon alfa-2a in patients who had undergone orthotopic liver transplantation.
The prophylaxis trial enrolled 54 patients within 3 weeks after OLT, and the treatment trial enrolled 67 patients 6 to 60 months after OLT.
In each trial, patients were randomized to treatment with once weekly injections of 180 g peginterferon alfa-2a or no antiviral treatment for 48 weeks and were followed up for 24 weeks thereafter.
Peginterferon alfa-2a treated patients had significantly lower hepatitis C virus RNA levels and more favorable changes in hepatic histological features compared with untreated controls.
|Incidence of acute rejection was similar in the treated and untreated groups in both the prophylaxis and treatment trials|
However, only 2 treated patients in the prophylaxis trial (8%) and 3 in the treatment trial (12%) achieved a sustained virological response.
In the prophylaxis trial, 8 patients (31%) in the peginterferon alfa-2a group and 9 (32%) in the untreated group were withdrawn prematurely; whereas in the treatment trial, 10 patients (30%) in the peginterferon alfa-2a group and 6 (19%) in the untreated group were withdrawn prematurely.
The incidence of acute rejection was similar in the treated and untreated groups in both the prophylaxis (12% vs. 21%) and treatment (12% vs. 0%) trials.
Dr Chalasani concluded, "Peginterferon alfa-2a treatment for 48 weeks is safe and tolerable and offers some efficacy in the post-OLT setting."
"Randomized controlled studies are needed to establish the efficacy of pegylated interferon and ribavirin in patients who have undergone OLT."