A randomized study comparing ribavirin and interferon alfa monotherapy for hepatitis C recurrence after liver transplantation

✍ Scribed by Edward J. Gane; Su-Kong Lo; Stephen M. Riordan; Bernard C. Portmann; Johnson Y. Lau; Nikolai V. Naoumov; Professor Roger Williams

• Publisher: John Wiley and Sons
• Year: 1998
• Tongue: English
• Weight: 120 KB
• Volume: 27
• Category: Article
• ISSN: 0270-9139
• DOI: 10.1002/hep.510270530

✦ Synopsis

Hepatitis C virus (HCV) infection usually recurs after orthotopic liver transplantation (OLT), and most patients develop graft damage. This study compared the efficacy of interferon alfa (IFN-␣) and ribavirin monotherapies in liver transplant recipients with chronic hepatitis C in the graft. Thirty OLT recipients with chronic hepatitis C were randomized to receive either IFN-␣ (3 MU three times a week) or ribavirin (up to 1.2 g daily) for 24 weeks. Virological, biochemical, and histological responses to treatment were assessed. Twenty-eight patients completed the treatment regimen, two ribavirin-treated patients being withdrawn because of severe hemolysis. Normalization of serum aspartate aminotransferase was achieved in 13 of 14 patients receiving ribavirin (93%) and 6 of 14 patients receiving IFN-␣ (43%; P ‫؍‬ .01). Lobular inflammation was reduced in 9/14 ribavirin-treated (64%) and 3 of 14 IFN-␣-treated patients (21%; P ‫؍‬ .05), each of whom had a biochemical response. However, the total histological activity index did not improve in either the interferon (P ‫؍‬ .43) or the ribavirin (P ‫؍‬ .96) group. Posttreatment viremia levels were significantly reduced in IFN-␣-treated (P ‫؍‬ .05) but not in ribavirin-treated (P ‫؍‬ .88) patients. Hemolysis occurred in all ribavirin-treated patients, with serum hemoglobin decreasing to F10 g/dL in 50%. Total leukocyte and lymphocyte counts decreased significantly during ribavirin treatment (P ‫؍‬ .02 and P ‫؍‬ .004, respectively). We concluded that in patients with chronic hepatitis C after OLT, IFN-␣ retains an antiviral effect whereas ribavirin is superior in achieving normalization of serum aspartate aminotransferase levels and reducing lobular inflammation, but not the total histological activity index. These findings provide a rationale for combination therapy in the post-OLT setting, although patients must be carefully monitored for hemoly-