Daily Interferon Therapy for Hepatitis C Virus Infection in Liver Transplant Recipients (original) (raw)
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Interferon-α therapy for hepatitis c virus infection after liver transplantation
Hepatology, 1994
The aims of this pilot study were to evaluate the safety and efficacy of interferon-%, for treatment of hepatitis C virus infection in liver transplant recipients, to monitor changes in hepatitis C virus RNA levels with treatment and to determine pretreatment parameters predictive of a complete response.
Digestive Diseases and Sciences, 2009
Background The recurrence of hepatitis C virus (HCV) after liver transplantation (OLT) leads to recurrent cirrhosis in up to 40% of patients. Aims To identify patients who profit the most from antiviral therapy and to delineate whether early treatment after OLT is effective to reach sustained virological response (SVR), we analyzed factors associated to SVR during pegylated interferon/ribavirin (PegIFN/RBV) therapy. Methods A retrospective analysis of efficiency and viral decline kinetics in 83 HCV-infected liver transplant recipients who received therapy with PegIFN/RBV was carried out. Results Forty-one of 83 (49.4%) patients became HCV RNA-negative. SVR was achieved in 26/83 (31.3%) patients. Viral decline of at least 2 log 10 (n = 47) at week 12 was significantly associated with an end-of-treatment (EOT) response. Eleven early viral response patients were not able to clear HCV RNA, whereas five patients without a 2 log decline achieved SVR. The highest predictive value for SVR was an undetectable viremia at week 24 (92%). Conclusions The outcome of antiviral combination therapy for HCV reinfection after OLT can be best predicted by week-24 virologic response. The high SVR rates in patients with detectable HCV RNA at week 12 might suggest a prolonged treatment protocol in liver transplant recipients.
Transplantation Proceedings, 2001
H EPATITIS C virus (HCV)-related cirrhosis is currently a leading indicator for orthotopic liver transplantation (OLT) worldwide, and results of several studies have confirmed that persistence of HCV infection is almost universal in HCV-RNA ϩ recipients. In fact, about 50% of such patients suffer chronic hepatitis of some severity, and about 30% of liver recipients develop cirrhosis within 5 years. 1,2 Interferon therapy for recurrent hepatitis C after liver transplantation has shown low efficacy once histologic hepatitis is established, 3,4 whereas recent studies have pointed out that combination therapy with interferon-␣2b (IFN) and ribavirin induces a high rate of sustained response (40% to 50%) in nontransplant patients with HCV chronic hepatitis. In the present study we tested a novel approach of combination of IFN and ribavirin, starting treatment 3 weeks after liver replacement. Such a strategy is based on the hypothesis that eradication of HCV could be optimized if therapy is instituted in the early phases following liver transplantation, when the viral load in the recipient may be lower and the graft still uninjured. 7
American Journal of Transplantation, 2006
The aim of our study was to assess the efficacy and safety of 48-weeks of full-dose peg-interferon-a-2a (n = 4) or a -2b (n = 51) plus ribavirin (>11 mg/kg/day) in a multicentric cohort of 55 patients ≥12 months after LT. All subjects had histologically proven HCV recurrence, excluding severe cholestatic recurrence. Mean age was 54.3 ± 9.7, 77% male, 90.9% genotype 1, 32.7% cirrhotics. All but 5 patients received monotherapy with tacrolimus (54.5%), cyclosporine (30.7%) or mycophenolate mofetil (5.5%). The rates of end-of-treatment response and sustained virological response (SVR) were 66.7% and 43.6%, respectively. Low baseline HCV-RNA (p = 0.005) and a length from LT to therapy between 2-4 years (p = 0.011) were predictors of SVR. The lack of achieving a viral load decrease ≥1-log 10 at week 4 and/or 2-log 10 at week 12 was 100% predictive of failure. The most frequent side effects were neutropenia (76,4%), anemia (60%) and infectious complications (30.9%). Toxicity led to peg-interferon withdrawal in 16 (29%) subjects. In 15 patients with post-treatment biopsy, the histological activity index was significantly improved (p = 0.006), whereas fibrosis did not change (p = 0.14). Three patients died (cholangitis, hepatic artery thrombosis and lung cancer). In conclusion, HCV therapy after LT was very effective, although it led to a significant rate of toxicity.
Interferon Treatment Improves Survival among Liver Transplant Recipients with Recurrent Hepatitis C
2013
Hepatitis C in the liver allograft recipient has an aggressive course. A significant proportion of such recipients develop graft fibrosis and cirrhosis within five years of transplantation. Treatment efficacy with standard or pegylated interferon and ribavirin is suboptimal compared to the immunocompetent individuals. However, the effect of such therapy on graft and patient survival remains unknown. Objectives: To determine the efficacy of interferon based therapies in liver transplantation recipients with recurrent hepatitis C, and to determine the effect of interferon treatment on graft and patient survival.
Introduction: Recurrence of hepatitis C virus (HCV) infection after orthotopic liver transplantation (OLT) is a virtually universal occurrence, and a significant proportion of patients develop chronic hepatitis and cirrhosis. The aim of this study was to evaluate the safety and efficacy of interferon (IFN)-a2b plus ribavirin (RIBA) in the treatment of recurrent HCV after OLT over the long term. Material and methods: Fifteen patients with recurrent HCV infection (positive serum HCV RNA, elevated serum aminotransferases, histological activity) were started on IFN-a2b (3-6 million units administered subcutaneously three times a week) plus RIBA (800-1200 mg/day) 18 AE 5 months after OLT. HCV RNA was determined 1, 3, 6, 9, 12 and 18 months after initiation of treatment. Liver biopsy was performed before and after therapy. The patients were followed up for a mean of 33 AE 5 months. Results: Thirteen patients (87%) were treated for at least 6 months and nine patients (60%) for 12 months. After 3 months, 11 patients (73%) were free from HCV RNA (o50 copies/ml); the virological end-of-treatment response was 67%. Five patients (33%) remained HCV RNA-negative 6 months posttreatment (sustained response (SR)). During the follow-up period, four patients (27%) died of liver failure, recurrent HCV after virological response, or HCC. The histological activity index improved significantly for both inflammatory activity and fibrosis, from 8.8 to 4.7 and from 7.3 to 4.8, respectively. In none of the patients were signs of rejection observed. Conclusion: Combination therapy with IFN and RIBA in transplanted patients with chronic hepatitis C is an effective treatment that results in a high virological SR rate. It is well tolerated and leads to an improvement in histological outcome.
Journal of …, 2002
Background/Aims: Interferon (IFN) with ribavirin combination therapy (CT) was proposed for the treatment of hepatitis C recurring in liver transplants. We assessed the efficacy of two protocols of CT in transplanted patients with recurrent severe hepatitis C virus (HCV) hepatitis. Methods: Fifty-seven patients (68% genotype 1b) were treated with IFN alfa-2b 3 million units three times weekly and oral ribavirin 800 mg/die for 6 or 12 months. Study end-points were the end of treatment (ETVR) and the 12-month post-therapy sustained virologic response (SVR; negative HCV-RNA). Results: ETVR was induced in 9/27 (33%) and in 7/30 patients (23%) treated, respectively, for 6 and 12 months (P ¼ 0.4); a SVR was induced in six (22%) of the former and five (17%) of the latter (P ¼ 0.4). HCV genotype non-1 patients responded better than genotype 1 (SVR: 43% in genotype non-1 versus 12% in genotype 1, P: 0.02). In ETV responders the hepatitis activity index improved by .2 points in biopsies taken after therapy compared to pre-therapy biopsies. Anemia and leukopenia required reduction of therapy in 51% of the patients. Conclusions: CT is efficacious in controlling HCV disease in about 20% of transplants with recurrent hepatitis C. Six months of therapy are as efficacious as 12 months.