Introduction: Recurrent hepatitis C (Hep C) is a major problem after liver transplantation. We analyzed our data on the virologic, biochemical and histological response with peg interferon (PEG-INF) maintenance therapy in HCV recipients.

Methods: Our center’s protocol was to administer PEG-INF alfa-2a 90 micrograms weekly in recipients who were initially treated with peg interferon and ribavirin who did not have a virologic response but had a biochemical response. Biochemical response was defined as normalization in ALT or reduction by 50% of peak ALT. Liver tests were obtained monthly and HCV RNA every 3 – 6 months. Liver biopsy was obtained prior to treatment and was offered to recipients after 6 months of maintenance therapy.

Results: 10 liver transplant recipients were treated with PEG-INF monotherapy with a median age of 59 and 9 were male. 5 patients were on tacrolimus, 2 patient on sirolimus, 2 patients on cyclosporine and 1 patient who had cholestatic Hep C not on any immunosuppression. Mean duration of peg interferon monotherapy was 15 ± 11 months. None of the patients cleared virus on maintenance therapy. Among the 10 patients mean ALT level was 203 ± 100 IU/L at pre-treatment (pre-treat) and 71 ± 42 IU/L at 12 months post-treatment (post-treat) as seen in figure 1 (p=0.001). The mean AST level was 164 ± 81 IU/L at pre-treat and 80 ± 56 IU/L at 12 months post-treat (p=0.01). Mean total bilirubin at pre-treat was 1.6 ± 1.3 mg/dL and at 12 months post-treat was 0.5 ± 0.4 mg/dL (p=0.08). 7 patients had a biochemical response. No patient developed rejection requiring steroids. The mean viral load was 10.4 ± 11.3 million IU/ml at pre-treat and 4.6 ± 4.1million IU/ml at 12 months post-treat (p=0.21). Among the 7 patients with follow up liver biopsies (median time between biopsies = 22 months) mean grade and stage on pre-treat biopsies were 2 and 2 and pos-treat biopsies were 2 and 2 respectively. 5 patients stopped maintenance therapy due to lack of a biochemical response or anemia.

Conclusions: In our experience 70% of Hep C liver transplant recipients had a biochemical response and no progression in liver fibrosis while on PEG-INF maintenance therapy.

Russo, M.: Speaker’s Bureau, Genentech.

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