Hepatitis C Virus Recurrence After Liver Transplantation: Analysis of Factors Related to Sustained Viral Response

Abstract Objectives To determine the efficacy and safety of pegylated interferon (peg-IFN) plus ribavirin to treat hepatitis C virus (HCV) recurrence, analyzing possible factors associated with sustained viral responses (SVR). Patients and Methods Forty-one patients (25 men and 16 women) of overall mean age of 50 years (range, 33–60) with recurrent HCV were treated with peg-IFN plus ribavirin including 33 (80%) subjects displayed genotype 1. The following variables were analyzed: gender, donor and recipient ages, immunosuppressant, genotype, treatment duration, early viral response (EVR), pretreatment viral load, degree of fibrosis, levels of alanine aminotransferase and γ-glutamyltransferase (IU/L), time since liver transplantation (OLT), use of stimulating factors (epoetin and granulocyte colony stimulating factor [G-CSF]) and side effects, and their association with SVR. The time from OLT to the start of treatment was 29 months (range, 6–90). Seventy-one percent of patients received cyclosporine and 29% tacrolimus. Results The mean treatment duration was 31 (range, 4–72) months with an EVR achieved in 12/38 (31.5%) of patients and a SVR in 16/41 (39%). Treatment was discontinued in 23 patients due to side effects. Epoetin was necessary in 29% and G-CSF in 10%. There were 3 cases of rejection (1 mild and 2 severe culminating in death). On univariate analysis genotype non-1B ( P < .02), pretherapy RNA ( P < .02), complete treatment, and EVR ( P < .005) were the only variables associated with SVR. The mean donor age of 43 years showed no statistical significance. Conclusion Therapy with peg-IFN plus ribavirin achieves an acceptable SVR, although not entirely free from severe side effects. Ensuring completion of the full treatment course is fundamental to achieve SVR.