Impact of pegylated interferon alfa-2a and ribavirin on hepatic fibrosis in liver transplant patients with recurrent hepatitis C: An open-label series

Background/Aims: Patients with recurrent hepatitis C are often treated with interferon-based therapy in an attempt to prevent cirrhosis requiring retransplantation. We describe our experience with 32 patients with recurrent HCV. Methodology: Patients were followed prospectively after starting pegylated interferon alfa-2a 180 mu g per week and ribavirin 1000-1200mg per day. HCV ribonucleic acid (HCVRNA) was repeated at three months, end of treatment (EOT) and six months after EOT for patients HCVRNA negative at EOT. Results: There were 22 males and 10 females. 21 patients have completed treatment, six remain on therapy and five were intolerant. In an intention-to-treat analysis, sustained viral eradication occurred in 40.6% of patients. Fibrosis scores were worse in eight patients of whom six were sustained responders. Three of these patients developed decompensated liver disease. Two were successfully retransplanted and remain HCVRNA negative after a mean follow-up of 11 months. Conclusions: Pegylated interferon alpha-2a and ribavirin were well tolerated in this small series. Sustained HCV eradication occurred in at least 40.6% of patients but progressive fibrosis occurred in 75% of sustained responders. This suggests that mechanisms other than recurrent HCV may be responsible for cirrhosis in sustained, responders who remain at risk of developing decompensated liver disease.