Clinical

Antiviral therapy slows progression of hepatitis C recurrence after liver transplant

Last Updated: 2007-06-12 12:19:17 -0400 (Reuters Health)

NEW YORK (Reuters Health) - For liver transplant patients who experience a recurrence of hepatitis C, antiviral therapy slows progression of liver fibrosis, according to the results of a study published in the May issue of Gastroenterology.

"Hepatitis C virus (HCV) infection is the leading cause of cirrhosis and hepatocellular carcinoma in the Western world and Japan, and HCV-related end-stage liver disease is the main indication of liver transplantation," Dr. Xavier Forns, of the Hospital Clinic, in Barcelona, Spain, and colleagues write. "Regretfully, infection of the liver graft with HCV occurs universally after liver transplantation, and chronic hepatitis and cirrhosis develop in a significant proportion of patients."

In their study, the researchers assessed the effect of antiviral therapy on disease progression in 81 HCV-infected liver transplant recipients. Patients with mild hepatitis C recurrence (fibrosis stage F0 to F2) were randomly assigned to receive 48 weeks of no treatment (group A, n = 27) or pegylated interferon alfa-2b and ribavirin (group B, n = 27). Patients with severe hepatitis C recurrence (F3 to F4, cholestatic hepatitis) all received treatment (group C, n = 27).

Liver biopsy was performed at baseline and after follow-up in all 81 patients.

A sustained virological response was achieved by 13 (48%) subjects with mild hepatitis who underwent antiviral treatment and five (18.5%) in patients with severe HCV recurrence. Liver fibrosis progressed by at least 1 stage 19 patients (70%) in patients with mild HCV recurrence who were not treated, 7 (26%) in those with mild disease who had active treatment, and 14 (54%) in patients with cholestatic hepatitis.

Multivariate analysis showed that treatment with pegylated interferon alfa-2b and ribavirin was the only variable independently associated with fibrosis improvement or stabilization (OR = 3.7, p = 0.009).

Adverse events were common during antiviral therapy. Severe adverse events occurred significantly more frequently in those with severe hepatitis C recurrence.

"These results suggest that treatment at early stages of hepatitis C recurrence is the best strategy to achieve a sustained virological response," Dr. Forns and colleagues conclude. "However, due to the high incidence of adverse events in this population, assessing the effect of treatment (and viral clearance) on disease progression is crucial."

Gastroenterology 2007;132:1746-1756.