ALPHA-INTERFERON TREATMENT OF HEPATITIS-C IN PATIENTS WITH LIVER ALLOGRAFTS TREATED WITH EITHER FK-506 OR CYCLOSPORINE-A

Objectives: To examine the efficacy of interferon therapy of hepatitis C in liver transplant recipients, to determine the effect of interfer on on allograft rejection rates, and to examine the effect of the prim ary immunosuppressive agent (FK-506/cyclosporin) on the above. Design: A non-randomized consecutive patient treatment study. Patients: Fifty -two liver allograft recipients with hepatitis C virus (HCV) associate d liver disease. All 52 patients had abnormal serum alanine aminotrans ferase (ALT) levels and in all, a liver biopsy confirmed the finding o f post-transplant viral hepatitis. Interventions: All patients were tr eated with interferon at a dose of 5 million units three times weekly, administered subcutaneously for 6 months. Main outcome measures: Norm alization of serum ALT levels was defined as a full response. A 50% re duction in serum ALT levels without normalization was defined as a par tial response. Results: No difference in entry ALT levels or white blo od cell counts was evident for the two groups based in the type of imm unosuppression used, either cyclosporin or FK-506. Similarly, no diffe rence in the response rate to interferon was observed based on the typ e of immunosuppression used. Improvement in ALT levels was not accompa nied by a concomitant improvement in hepatic histology. Overall, Knode ll scores for histology deteriorated in two-thirds of the patients des pite interferon treatment. Conclusions: The use of interferon in liver transplant recipients reduces serum ALT levels but has little effect, if any, on hepatic allograft histopathology. In most patients, histol ogy worsens despite interferon therapy. No difference in interferon re sponse rates were observed between liver allograft recipients receivin g either cyclosporin or FK-506.