THE EFFICACY OF PROPHYLACTIC INTERFERON-ALPHA-2B IN PREVENTING RECURRENT HEPATITIS-C AFTER LIVER-TRANSPLANTATION

Clinical recurrence of hepatitis C after liver transplantation can lea d to cirrhosis, liver failure, and death. In patients undergoing liver transplantation for hepatitis C, we assessed the efficacy of interfer on alfa-2b (IFN) in preventing recurrent hepatitis. We randomized 86 p atients to either an IFN group (3 MU three times a week starting withi n 2 weeks after transplantation and continued for 1 year) or a control (no IFN) group. Recurrence, the primary end point, was diagnosed on b iopsy performed at 1 year or for abnormal biochemistries. HCV RNA leve ls were measured by branched-chain DNA (bcDNA) assay and arbitrarily d efined as low, moderate, or high (<10 x 10(5), 10-100 x 10(5), or >100 x 10(5) Eq/mL, respectively). Data on 30 IFN patients and 41 no-IFN p atients who survived greater than or equal to 3 months were reviewed. Mean follow-up was 669 +/- 228 days for IFN patients and 594 +/- 254 d ays for no-IFN patients. IFN patients were less likely to develop recu rrent hepatitis (8 IFN vs. 22 no-IFN patients, P =.017, log rank analy sis). IFN and 1-month HCV RNA level were independent predictors of rec urrence. IFN reduced the risk of recurrence by a factor of 0.4 (P=.04, Cox proportional hazards model); HCV RNA level >100 x 105 Eq/mL at 1 month after transplantation increased the risk by a factor of 3.1 (P=. 01), Low moderate, and high viral levels at 1 and 3 months were associ ated with significantly different rates of recurrence in IFN patients (P =.05 at 1 month and P =.003 at 3 months) but not in untreated patie nts (P =.28 at 1 month and P =.25 at 3 months). In patients with two o r more rejections, the risk of recurrence was increased by a factor of 2.17 (P=.05), On 47 1-year biopsies (24 IFN; 23 no IFN), piecemeal ne crosis was more common in untreated patients (P <.02). One- and 2-year patient survival, respectively, was 96% and 96% with IFN and 91.2% an d 87.2% without (P = NS), Prophylactic IFN reduced the incidence of re current hepatitis after transplant. Although IFN was most effective in patients with low HCV RNA levels, we also noted an effect in patients with moderate levels. IFN did not prevent viremia, suggesting that it may work through alternative mechanisms.