Antiviral treatment withdrawal in viremic HCV-positive liver transplant patients: impact on viral loads, allograft function and morphology
Article first published online: 26 JUN 2006
Volume 26, Issue 7, pages 811–816, September 2006
How to Cite
Kornberg, A., Küpper, B., Tannapfel, A., Thrum, K., Bärthel, E. and Settmacher, U. (2006), Antiviral treatment withdrawal in viremic HCV-positive liver transplant patients: impact on viral loads, allograft function and morphology. Liver International, 26: 811–816. doi: 10.1111/j.1478-3231.2006.01301.x
- Issue published online: 28 JUN 2006
- Article first published online: 26 JUN 2006
- Received 15 February 2006,accepted 4 May 2006.
- liver transplantation;
- recurrent hepatitis C;
Abstract: Background: The aim of this study was to evaluate the clinical long-term consequences of antiviral treatment discontinuation in viremic hepatitis C virus (HCV)-positive liver transplant recipients.
Methods: Twenty-five HCV-positive patients after liver transplantation were included in this study. After diagnosing recurrent hepatitis C, a combination therapy with interferon-α2b and ribavirin for a minimum of 12 months was initiated. Viremia levels and allograft function were monitored continuously. Allograft biopsies were performed yearly, analyzing grading of inflammation and staging of fibrosis.
Results: HCV recurrence rate was 100%. Up to 114 months post-transplantation, sustained virological response rate was 64%. Treatment discontinuation in virological nonresponders led subsequently to a significant increase of viral loads and deterioration of allograft function (P<0.05) within 1 month. In three patients, a fibrosing cholestatic syndrome developed, resulting in one patient death. Antiviral retherapy was maintained for a mean of 33 months, leading to a significant decline of aminotransferases (P<0.05) as well as decreasing serum levels of bilirubin and HCV-RNA within 6 months. In addition, development of severe allograft fibrosis was prevented despite persistent viral loads.
Conclusion: Our study suggests that antiviral treatment withdrawal carries the risk of severe disease progression in persistently viremic HCV-positive liver transplant patients.