Treatment of recurrent hepatitis C infection after liver transplantation with combination of pegylated interferon α2b and ribavirin: An open-label series

Hector Rodriguez-Luna, Amer Khatib, Pratima Sharma, Giovanni De Petris, James W. Williams, Jose Ortiz, Kathleen Hansen, David Mulligan, Adyr Moss, David D. Douglas, Vijayan Balan, Jorge Rakela, Hugo E Vargas

Research output: Contribution to journalArticle

169 Citations (Scopus)

Abstract

Background. Hepatitis C virus (HCV) recurrence after orthotopic liver transplantation (OLT) is universal. We aimed to evaluate the efficacy and safety of pegylated interferon (PEG-IFN) and ribavirin (RIB) in the treatment of post-OLT HCV recurrence. Methods. Thirty-seven patients with recurrent HCV after OLT were screened and began treatment. Nineteen patients have completed therapy. PEG-IFN was started at a dose of 0.5 μg/kg per week and titrated toward a maximum dose of 1.5 μg/kg per week. RIB was started at a dose of 400 mg per day and titrated toward a maximum of 1000 mg per day, as tolerated. Therapy continued for 1 year after HCV replication was undetectable by reverse transcriptase-polymerase chain reaction and was discontinued if there was no virologic clearance at 48 weeks. Results. Twelve patients (63%) completed the combination regimen. Therapy was discontinued in seven (37%) patients. Seven patients (37%) had undetectable viral load at the end of treatment. Of those, five patients (26%) had sustained viral response 6 months after discontinuation of therapy. Five patients (26%) had no virologic response. Necro-inflammatory score declined from 5.22 to 2.89 (P=0.05) in nonresponders versus 6.8 to 2.6 (P<0.01) in responders. Fibrosis stage did not change in either group. Genotype 1-infected patients had a lower likelihood of attaining end of treatment or sustained viral response (P<0.05 for both). Conclusions. Post-OLT HCV recurrence can be safely treated with PEG-IFN and RIB. Bone marrow toxicity, depression, and rejection are limiting factors that require aggressive management. There was short-term histologic benefit to the use of this regimen, even in those patients without viral clearance.

Original languageEnglish (US)
Pages (from-to)190-194
Number of pages5
JournalTransplantation
Volume77
Issue number2
DOIs
StatePublished - Jan 27 2004

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Ribavirin
Hepatitis C
Liver Transplantation
Interferons
Hepacivirus
Infection
Therapeutics
Recurrence
Virus Replication
Viral Load
Reverse Transcriptase Polymerase Chain Reaction
Fibrosis
Bone Marrow
Genotype
Safety

ASJC Scopus subject areas

  • Transplantation
  • Immunology

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Treatment of recurrent hepatitis C infection after liver transplantation with combination of pegylated interferon α2b and ribavirin : An open-label series. / Rodriguez-Luna, Hector; Khatib, Amer; Sharma, Pratima; De Petris, Giovanni; Williams, James W.; Ortiz, Jose; Hansen, Kathleen; Mulligan, David; Moss, Adyr; Douglas, David D.; Balan, Vijayan; Rakela, Jorge; Vargas, Hugo E.

In: Transplantation, Vol. 77, No. 2, 27.01.2004, p. 190-194.

Research output: Contribution to journalArticle

Rodriguez-Luna, H, Khatib, A, Sharma, P, De Petris, G, Williams, JW, Ortiz, J, Hansen, K, Mulligan, D, Moss, A, Douglas, DD, Balan, V, Rakela, J & Vargas, HE 2004, 'Treatment of recurrent hepatitis C infection after liver transplantation with combination of pegylated interferon α2b and ribavirin: An open-label series', Transplantation, vol. 77, no. 2, pp. 190-194. https://doi.org/10.1097/01.TP.0000100481.14514.BB
Rodriguez-Luna, Hector ; Khatib, Amer ; Sharma, Pratima ; De Petris, Giovanni ; Williams, James W. ; Ortiz, Jose ; Hansen, Kathleen ; Mulligan, David ; Moss, Adyr ; Douglas, David D. ; Balan, Vijayan ; Rakela, Jorge ; Vargas, Hugo E. / Treatment of recurrent hepatitis C infection after liver transplantation with combination of pegylated interferon α2b and ribavirin : An open-label series. In: Transplantation. 2004 ; Vol. 77, No. 2. pp. 190-194.
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abstract = "Background. Hepatitis C virus (HCV) recurrence after orthotopic liver transplantation (OLT) is universal. We aimed to evaluate the efficacy and safety of pegylated interferon (PEG-IFN) and ribavirin (RIB) in the treatment of post-OLT HCV recurrence. Methods. Thirty-seven patients with recurrent HCV after OLT were screened and began treatment. Nineteen patients have completed therapy. PEG-IFN was started at a dose of 0.5 μg/kg per week and titrated toward a maximum dose of 1.5 μg/kg per week. RIB was started at a dose of 400 mg per day and titrated toward a maximum of 1000 mg per day, as tolerated. Therapy continued for 1 year after HCV replication was undetectable by reverse transcriptase-polymerase chain reaction and was discontinued if there was no virologic clearance at 48 weeks. Results. Twelve patients (63{\%}) completed the combination regimen. Therapy was discontinued in seven (37{\%}) patients. Seven patients (37{\%}) had undetectable viral load at the end of treatment. Of those, five patients (26{\%}) had sustained viral response 6 months after discontinuation of therapy. Five patients (26{\%}) had no virologic response. Necro-inflammatory score declined from 5.22 to 2.89 (P=0.05) in nonresponders versus 6.8 to 2.6 (P<0.01) in responders. Fibrosis stage did not change in either group. Genotype 1-infected patients had a lower likelihood of attaining end of treatment or sustained viral response (P<0.05 for both). Conclusions. Post-OLT HCV recurrence can be safely treated with PEG-IFN and RIB. Bone marrow toxicity, depression, and rejection are limiting factors that require aggressive management. There was short-term histologic benefit to the use of this regimen, even in those patients without viral clearance.",
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T1 - Treatment of recurrent hepatitis C infection after liver transplantation with combination of pegylated interferon α2b and ribavirin

T2 - An open-label series

AU - Rodriguez-Luna, Hector

AU - Khatib, Amer

AU - Sharma, Pratima

AU - De Petris, Giovanni

AU - Williams, James W.

AU - Ortiz, Jose

AU - Hansen, Kathleen

AU - Mulligan, David

AU - Moss, Adyr

AU - Douglas, David D.

AU - Balan, Vijayan

AU - Rakela, Jorge

AU - Vargas, Hugo E

PY - 2004/1/27

Y1 - 2004/1/27

N2 - Background. Hepatitis C virus (HCV) recurrence after orthotopic liver transplantation (OLT) is universal. We aimed to evaluate the efficacy and safety of pegylated interferon (PEG-IFN) and ribavirin (RIB) in the treatment of post-OLT HCV recurrence. Methods. Thirty-seven patients with recurrent HCV after OLT were screened and began treatment. Nineteen patients have completed therapy. PEG-IFN was started at a dose of 0.5 μg/kg per week and titrated toward a maximum dose of 1.5 μg/kg per week. RIB was started at a dose of 400 mg per day and titrated toward a maximum of 1000 mg per day, as tolerated. Therapy continued for 1 year after HCV replication was undetectable by reverse transcriptase-polymerase chain reaction and was discontinued if there was no virologic clearance at 48 weeks. Results. Twelve patients (63%) completed the combination regimen. Therapy was discontinued in seven (37%) patients. Seven patients (37%) had undetectable viral load at the end of treatment. Of those, five patients (26%) had sustained viral response 6 months after discontinuation of therapy. Five patients (26%) had no virologic response. Necro-inflammatory score declined from 5.22 to 2.89 (P=0.05) in nonresponders versus 6.8 to 2.6 (P<0.01) in responders. Fibrosis stage did not change in either group. Genotype 1-infected patients had a lower likelihood of attaining end of treatment or sustained viral response (P<0.05 for both). Conclusions. Post-OLT HCV recurrence can be safely treated with PEG-IFN and RIB. Bone marrow toxicity, depression, and rejection are limiting factors that require aggressive management. There was short-term histologic benefit to the use of this regimen, even in those patients without viral clearance.

AB - Background. Hepatitis C virus (HCV) recurrence after orthotopic liver transplantation (OLT) is universal. We aimed to evaluate the efficacy and safety of pegylated interferon (PEG-IFN) and ribavirin (RIB) in the treatment of post-OLT HCV recurrence. Methods. Thirty-seven patients with recurrent HCV after OLT were screened and began treatment. Nineteen patients have completed therapy. PEG-IFN was started at a dose of 0.5 μg/kg per week and titrated toward a maximum dose of 1.5 μg/kg per week. RIB was started at a dose of 400 mg per day and titrated toward a maximum of 1000 mg per day, as tolerated. Therapy continued for 1 year after HCV replication was undetectable by reverse transcriptase-polymerase chain reaction and was discontinued if there was no virologic clearance at 48 weeks. Results. Twelve patients (63%) completed the combination regimen. Therapy was discontinued in seven (37%) patients. Seven patients (37%) had undetectable viral load at the end of treatment. Of those, five patients (26%) had sustained viral response 6 months after discontinuation of therapy. Five patients (26%) had no virologic response. Necro-inflammatory score declined from 5.22 to 2.89 (P=0.05) in nonresponders versus 6.8 to 2.6 (P<0.01) in responders. Fibrosis stage did not change in either group. Genotype 1-infected patients had a lower likelihood of attaining end of treatment or sustained viral response (P<0.05 for both). Conclusions. Post-OLT HCV recurrence can be safely treated with PEG-IFN and RIB. Bone marrow toxicity, depression, and rejection are limiting factors that require aggressive management. There was short-term histologic benefit to the use of this regimen, even in those patients without viral clearance.

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