Interferon-alpha and combined with ribavirin in HCV liver transplant recipients: Efficacy and predictors of response

Optimal dose, duration and timing of antiviral treatment of hepatitis C virus (HCV) recurrence after orthotopic liver transplantation (OLT) have not been established yet. The identification of factors predictive of response to interferon (IFN) treatment remains a crucial issue in the liver transplant setting. In this prospective study, 26 OLT patients were treated with standard interferon-alpha (IFN-alpha)–2b (2 MU daily) for 12 months or standard IFN-alpha–2b for 3 months followed by pegylated IFN (PEG-IFN)-alpha–2b (1.5 mcg/kg/week) for 9 months. IFN was combined with ribavirin (10–12mg/kg/day) in all patients. The sustained virological response (SVR) rate in the standard IFN group and in the PEG-IFN group was 27.3% and 26.7%, respectively. Interestingly, only 2 of 7 (28.6%) patients with SVR had concomitant end of treatment histological response (EOTHR), whereas 9 of 19 (47.4%) viral non-responders showed EOTHR. Univariate analysis indicated that HCV genotype non–1, presence of high baseline alanine aminotransferase (ALT) value and the time interval between OLT and IFN therapy predicted SVR. In the multivariate model, baseline ALT remained a significant predictor of SVR. The body mass index (BMI) was negatively correlated with EOTHR in the univariate and multivariate analysis. In conclusion, the efficacy of both antiviral treatment regimens has been shown to be markedly lower after OLT as compared to the non-transplant setting. Histological response does not mirror virological response. Thus, failure to eradicate HCV should not necessarily lead to treatment discontinuation if serial liver biopsies demonstrate histological response.

HCV - Hepatitis C - IFN - Interferon-alpha - Liver Transplantation - Rivavirin