The Effect and Safety of the Treatment of Recurrent Hepatitis C Infection After Orthotopic Liver Transplantation With Pegylated Interferon α2b and Ribavirin

• Published in: Transplantation proceedings 2011-12, Vol.43 (10), p.3824-3828
• Main Authors: Perrakis, A, Yedibela, S, Schuhmann, S, Croner, R, Schellerer, V, Demir, R, Hohenberger, W, Müller, V
• Format: Article
• Language: English
• Subjects: Aged; Antiviral Agents - administration & dosage; Antiviral Agents - adverse effects; Antiviral Agents - therapeutic use; Biological and medical sciences; Biomarkers - blood; Biopsy; Drug Therapy, Combination; Female; Fundamental and applied biological sciences. Psychology; Fundamental immunology; Germany; Hepacivirus - genetics; Hepatitis C - complications; Hepatitis C - diagnosis; Hepatitis C - drug therapy; Human viral diseases; Humans; Infectious diseases; Interferon-alpha - administration & dosage; Interferon-alpha - adverse effects; Interferon-alpha - therapeutic use; Liver Cirrhosis - diagnosis; Liver Cirrhosis - surgery; Liver Cirrhosis - virology; Liver Transplantation - adverse effects; Liver, biliary tract, pancreas, portal circulation, spleen; Male; Medical sciences; Middle Aged; Polyethylene Glycols - administration & dosage; Polyethylene Glycols - adverse effects; Polyethylene Glycols - therapeutic use; Recombinant Proteins - administration & dosage; Recombinant Proteins - adverse effects; Recombinant Proteins - therapeutic use; Recurrence; Ribavirin - administration & dosage; Ribavirin - adverse effects; Ribavirin - therapeutic use; RNA, Viral - blood; Surgery; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the digestive system; Time Factors; Tissue, organ and graft immunology; Treatment Outcome; Viral diseases; Viral hepatitis; Viral Load
• ISSN: 0041-1345; 1873-2623
• DOI: 10.1016/j.transproceed.2011.08.103

Abstract Introduction Recurrent hepatitis C infection in the posttransplant setting is a serious problem. The aim of this study was to evaluate the efficacy, safety, indications, optimal time of administration and adequate duration of antiviral therapy with pegylated interferon alpha 2 b (PEG-IFN) and ribavirin (RIB). Patients and methods Between 2003 and 2009, 16 patients received antiviral therapy (PEG-IFN: 0.8–1.6 μg/kg/wk, RIB 800–1200 mg/d) for at least 6 months. Patients with a biochemical without a virologicalresponse after 12 months of therapy received antiviral treatment for a further 6 months. Hepatitis C virus load was determined at 1, 3, 6, and 12 months after start of therapy. Liver biopsy was performed in all patients before the beginning and after the end of treatment. Results The mean period of antiviral therapy was 14 months. The four patients who received the full-length treatment (12 months, 33%) showed sustained virological responses (SVR) and 8 showed virological and biochemical responses (VR, BR). Patients with SVR showed significant improvement in the grading and staging of HAI (histological activity index; P = .03). Nine patients had several side effects under antiviral treatment. Acute rejection episodes were not observed. Conclusion The antiviral treatment combination using PEG-IFN and RIB for recurrent hepatitis C is effective procedure. The SVR of 33% after 12 months of treatment with significant improvement in HAI grading and staging and stable HAI in all treated patients favor early initiation and 12-month administration of antiviral treatment. Furthermore, all patients with BR without VR, who underwent antiviral treatment for a further 6 months, achieved a VR. However, the optimal duration of treatment needs to be investigated in large prospective studies.