Ribavirin with either standard or pegylated interferon to treat recurrent hepatitis C after liver transplantation

Aim To investigate the efficacy of two anti-viral protocols in hepatitis C virus-reinfected liver transplant recipients. Methods In this prospective study, 26 liver transplant patients were treated with standard interferon-alpha 2b for 12 months or standard interferon-alpha 2b for 3 months followed by pegylated interferon-alpha 2b for 9 months. Interferon was combined with ribavirin in all patients. The histological course of the study population was compared with an untreated historic control group (n = 38) with similar baseline characteristics. Results The sustained virological response rates in the standard interferon group and in the pegylated interferon group were 27.3% and 26.7%, respectively. Only 29% of patients with sustained virological response had end of treatment histological response, whereas 47% of viral non-responders showed end of treatment histological response. The percentage of patients with histological improvement was significantly higher in the study population when compared to the controls. Univariate analysis indicated that hepatitis C virus genotype non-1, high baseline alanine aminotransferase, the time interval between liver transplant and interferon therapy and the body mass index predicted sustained virological response. In the multivariate model, baseline alanine aminotransferase and the body mass index remained a significant predictor of sustained virological response. Conclusions Both treatment regimens offer similar efficacy profiles. Failure to eradicate hepatitis C virus should not lead to treatment discontinuation if serial liver biopsies demonstrate histological response.