Interferon-alpha and ribavirin for the treatment of recurrent hepatitis C after liver transplantation

Background Initial studies utilizing interferon-alpha and ribavirin for the treatment of recurrent hepatitis C virus (HCV) infection after liver trans plantation showed promising results. Here we report our single-center exper ience using this combination therapy. Methods. Liver transplant recipients with recurrent HCV (elevated serum ami notransferases, positive serum HCV RNA, and biopsy-proven hepatitis without rejection) received interferon-alpha (1.5-3 million units subcutaneously t hree times a week) and ribavirin (400-1000 mg p,o. daily) for 12 months or more. Serum aminotransferases, HCV RNA, and severity of hepatitis were foll owed. Results. Thirty-two patients have been treated for at least 3 months, inclu ding 13 who have been on 12 or more months of therapy. Three died from allo graft failure due to recurrent HCV, Dose reductions of interferon-alpha and /or ribavirin occurred in 22 patients. Thirteen had their medications perma nently discontinued for severe adverse effects. Twenty-sis patients (81%) h ad a biochemical response (BR; normalization of serum aminotransferases) af ter 3 months. End-of-treatment and sustained BR were 77% and 71%, respectiv ely. Mean viral loads decreased 68-77%; however, only three patients became serum HCV RNA negative. After 12 months of therapy, no histological improv ement was observed in 11 patients who were biopsied, Patients who received mycophenolate mofetil or daclizumab had a less likelihood of achieving a BR , Conclusions. A significant number of patients did not tolerate interferon-a lpha or ribavirin, Although BR was excellent and mean viral loads decreased significantly, virological clearance was poor and no histological improvem ent was noted. A more efficacious treatment with less adverse effects for r ecurrent HCV after liver transplantation is needed.