Clinical and histological efficacy of pegylated interferon and ribavirin therapy of recurrent hepatitis C after liver transplantation

Hospital Universitario 12 de Octubre, Madrid, Madrid, Spain
Liver Transplantation (Impact Factor: 4.24). 12/2006; 12(12):1805-12. DOI: 10.1002/lt.20883
Source: PubMed


Treatment of recurrent hepatitis C in liver transplant is controversial. The aim of our study was to evaluate the clinical and histological efficacy of pegylated interferon alpha 2b (PEG-IFN) and ribavirin therapy of recurrent hepatitis C after liver transplantation (LT). We prospectively included 47 liver transplant patients with: 1) a positive test for hepatitis C virus (HCV)-ribonucleic acid (RNA) in serum; 2) alanine aminotransferase (ALT) >45 UI/mL; and 3) a liver biopsy showing chronic hepatitis without rejection in the previous 2 months. Patients received PEG-IFN (1.5 microg/kg/week) and ribavirin (800-1,000 mg/day) for 12 months. Follow-up was based on biochemical (ALT), virological (RNA-HCV), and histological (liver biopsy) examinations. Follow-up lasted a minimum of 6 months after the end of antiviral therapy. Sustained virological response (SVR) was achieved in 23% of the patients. A total of 33 (70%) patients had normalized ALT levels at the end of therapy. Inflammatory portal and lobular score declined significantly in patients with SVR (P < 0.05) but not in nonresponder patients. Fibrosis did not change significantly in either group. SVR was significantly associated with low gamma-glutamyltransferase GGT (P = 0.04) and HCV-RNA levels (P = 0.03), a virological response at 12 weeks (P = 0.002) and patient's compliance (P = 0.04). Ten (21%) patients were withdrawn prematurely due to adverse effects. In conclusion, Therapy with PEG-IFN and ribavirin achieved SVR and a significant histological improvement in 23% of liver transplant recipients with chronic hepatitis C. Toxicity is an important drawback of this therapy.

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Available from: José A Solís-Herruzo, Sep 08, 2014
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    • "2006 Spain R, U NA 36 a HCV RNA+, CH on liver biopsy, age >18 years Coexistent graft disease (vascular, biliary, autoimmune or infectious conditions), history of heart disease Oton et al. [21] 2006 Spain P, U NA 55 HCV RNA+, abnormal ALT >6 months, CH without rejection (F > 1 Ishak or lobular hepatitis), adults, >1-year post-LT, steroid withdrawal >6 months, no change in IS within 3 months HIV, severe cholestatic recurrence, creatinine >2.2 mg/dL, severe cardiopulmonary disease, Hgb <10 g/dL, neutrophil count <1200/lL, platelet count <50,000/lL Mukherjee et al. [31] 2006 US R, U 38 32 HCV RNA+, ALT > 1.5 Â ULN, CH without rejection (inflammation or steatosis), 19 P age 6 75 years Rejection, renal transplant, other graft injuries, Hgb <10 g/dL, neutrophil count <1500/lL, platelet count <50,000/lL, creatinine >1.8 mg/dL Mukherjee et al. [22] 2006 US P, U 48 39 HCV RNA+, ALT > 1.5Â ULN, CH without rejection (inflammation or steatosis), 19 P age 6 75 years Rejection, renal transplant, other graft injuries, Hgb <10 g/dL, neutrophil count <1500/lL, platelet count <50,000/lL, creatinine >1.8 mg/dL, severe depression Fernandez et al. [23] 2006 Spain P, U 88 47 HCV RNA+, ALT > 45 IU/ L, CH without rejection in liver biopsy within 2 months (F P 2 or F = 1 + HAI P 3), age >18 years, IFN-naive post- LT Normal ALT, biliary/ vascular complications, Hgb <10 g/dL, neutrophil count <1500/lL, platelet count <65,000/lL, creatinine clearance <35 mL/min, renal transplantation, severe depression, ischemic cardiopathy (continued on next page) "
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    ABSTRACT: The aim of our study was to conduct a systematic review of studies evaluating antiviral therapy with pegylated interferon (PEG-IFN) alfa in combination with ribavirin for the management of recurrent hepatitis C after liver transplantation. Data sources included electronic databases and a manual search. Studies evaluating the efficacy and tolerability of PEG-IFN alfa with ribavirin in patients with recurrent hepatitis C were selected for inclusion. The information extracted from each of the selected publications included study design details, patient characteristics, treatment regimens and efficacy and tolerability end points. Nineteen studies including 611 patients were identified. PEG-IFN alfa-2b was used in 16 studies. The mean rate of SVR was 30.2% (range, 8-50%). Dose reduction and discontinuation of treatment were common in these studies (73% and 27.6%, respectively). The lack of an early virologic response (EVR) at 3 months of therapy was the most frequently described predictive factor of nonresponse. Treatment discontinuation and dose reductions due to adverse events were frequent and possibly represent important obstacles to attainment of SVR. EVR at 3 months of treatment should be considered an important predictor of treatment outcome.
    Full-text · Article · Sep 2008 · Journal of Hepatology
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    ABSTRACT: To review the use of antiviral therapy as prophylaxis or treatment of virus C liver disease in the liver transplantation setting. A search was made of the literature in PubMed with the strategy liver transplantation AND hepatitis C AND (interferon OR peginterferon OR ribavirin) from 1966 to June 2007 and a manual search of the journals Gastroenterología y Hepatología, Journal of Hepatology and Hepatology between 2001 and June 2007, to identify publications and communications to congresses relating to the subject. The studies identified were selected and evaluated. A total of 48 articles were chosen for review. Hepatitis C virus is one of the main indications for liver transplantation. Post-transplant re-infection is immediate and almost universal, and results, in many cases, in a recurrent liver disease that reduces the patients survival. Four basic therapeutic strategies have been studied: pre-transplant anti-viral treatment, prophylaxis, early or preventative treatment and treatment of acute or chronic recurrent hepatitis C. Currently, the hepatitis C treatment in the liver transplantation setting is based on the use of peginterferon associated with ribavirin as pre-transplant treatment in selected patients or as treatment of recurrent post-transplant hepatitis C, achieving sustained virological responses of around 20% and 35% respectively. The main limitation of these treatments is the high frequency of the adverse effects and interruptions to treatment, meaning it is important to carry out strict follow-up of the treatment safety.
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