Pegylated Interferon Plus Ribavirin in Patients with HCV Recurrence after Liver Transplantation

Recurrent hepatitis C virus (HCV) infection after orthotopic liver transplantation is a major cause of graft loss in patients with chronic hepatitis C.

Researchers from Humboldt University in Berlin conducted a study to evaluate the efficacy and safety of pegylated interferon alfa-2b (Peg-Intron) plus ribavirin combination therapy for post-transplant HCV recurrence, and analyzed the influence of antiviral treatment on the histological course of recurrent liver disease.

The study, reported in the July 2006 issue of Transplantation, included 25 patients with recurrent HCV (20 with genotype 1 and 5 with genotypes 2, 3, or 4) who were treated with 1 mg/kg/week pegylated interferon plus 600 mg daily ribavirin for 48 weeks. HCV viral load prior to treatment was less than 1,000,000 IU/mL in 11 of the 25 patients. All patients underwent liver biopsy prior to treatment and after 72 weeks.

Results

17 of 25 patients (68%) became HCV RNA negative at the end of treatment.

9 of 25 patients (36%) achieved sustained virological response (SVR).

Liver biopsy specimen showed an increase in fibrosis from 1.7 to 2.0 within 72 weeks.

Side effects included neutropenia (60%) and anemia (36%).

Patients with hematological side effects were treated with granulocyte colony-stimulating factor (G-CSF), erythropoietin, and/or pegylated interferon/ribavirin dose reduction.

Conclusion

"The use of [pegylated interferon] is safe and effective in patients with recurrent HCV," the authors concluded. "Treatment of side effects, especially neutropenia or anemia, helped to maintain antiviral therapy." However, they added, despite the fact that 68% achieved virological response during treatment, patients on average experienced further progression of recurrent liver disease.

8/18/06

Reference
U Neumann, G Puhl, M Bahra, and others. Treatment of patients with recurrent hepatitis C after liver transplantation with peginterferon alfa-2B plus ribavirin. Transplantation 82(1): 43-47. July 2006.