Treatment for Recurrent Hepatitis C Virus Infection After Liver Transplantation

• Published in: Transplantation proceedings Vol. 41; no. 3; pp. 891 - 894
• Main Authors: Balbi, E, Leal, C.R.G, Pacheco-Moreira, L.F, Pousa, F.S, Covelo, M.C, Gonzalez, A.C, Oliveira, P.V, Agoglia, L, Roma, J, Cariús, L.P, Enne, M
• Format: Journal Article Conference Proceeding
• Language: English
• Published: Amsterdam Elsevier Inc 01-04-2009; Elsevier
• Subjects: Antiviral Agents - therapeutic use; Biological and medical sciences; Biopsy; Female; Fundamental and applied biological sciences. Psychology; Fundamental immunology; Hepatitis C - drug therapy; Hepatitis C - surgery; Human viral diseases; Humans; Immunosuppressive Agents - therapeutic use; Infectious diseases; Interferon-alpha - therapeutic use; Liver - pathology; Liver Cirrhosis - surgery; Liver Cirrhosis - virology; Liver Transplantation - adverse effects; Liver Transplantation - immunology; Liver Transplantation - pathology; Liver, biliary tract, pancreas, portal circulation, spleen; Male; Medical sciences; Middle Aged; Polyethylene Glycols - therapeutic use; Postoperative Complications - drug therapy; Postoperative Complications - virology; Recombinant Proteins; Recurrence; Retrospective Studies; Ribavirin - therapeutic use; RNA, Viral - blood; Surgery; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the digestive system; Tissue, organ and graft immunology; Viral diseases; Viral hepatitis; Viral Load; Relapse; Digestive system; Liver; Hepatic disease; Recurrent; Homotransplantation; Infection; Medicine; Treatment; Surgery; Viral disease; Digestive diseases; Graft; Viral hepatitis C; Liver transplantation
• ISSN: 0041-1345; 1873-2623
• DOI: 10.1016/j.transproceed.2009.02.006

Abstract Cirrhosis due to hepatitis C virus (HCV) infection is the current leading indication for orthotopic liver transplantation (OLT) in the world. This series reports our program's experience with the treatment of HCV infection after the development of histological hepatitis. Between March 2002 and June 2008, patients with recurrent HCV were selected for treatment if the liver biopsy showed at least the F2 degree of Metavir score. HCV viral load was measured at 4, 12 and 24 weeks as well as at the end of treatment and at 6 months thereafter for patients who became HCV RNA negative (sustained virological response [SVR]). In this period, we performed 287 liver transplantations in 279 patients, including 117 (42%) who had HCV cirrhosis as the indication for OLT of whom 25 were eligible for antiviral treatment. Twelve patients completed treatment, 7 remain on treatment, and 6 were discontinued. The principal collateral effect was anemia. Only 1 patient had an episode of acute cellular rejection, which responded to adjustment of immunosuppression. Antiviral treatment in transplanted patients was feasible and did not seem to induce severe immunological effects. Adjuvant therapies to reduce cytopenias are frequently required, principally erythropoietin. The best results were observed with the pegylated interferon alfa (PEG) plus ribavirin (RBV) group: 38.9% of SVR. We recommend antiviral treatment of eligible patients with confirmed HCV recurrence using PEG plus RBV.