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Combined therapy with interferon and low-dose ribavirin in posttransplantation recurrent hepatitis C: a pragmatic study.
- Source :
-
Liver transplantation : official publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society [Liver Transpl] 2001 Oct; Vol. 7 (10), pp. 870-6. - Publication Year :
- 2001
-
Abstract
- Recurrent hepatitis C is a common problem after liver transplantation that can progress to liver cirrhosis of the graft. Preliminary reports of combination treatment with interferon (IFN) and ribavirin have been promising, but long-term follow-up data are not yet available. We report our experience with 1 year of combination therapy with IFN (3 million units thrice weekly) and low-dose ribavirin (600 mg/d), followed by long-term ribavirin monotherapy in 18 patients with moderate to severe recurrent hepatitis C and a median follow-up of 32 months after the completion of combined therapy. All patients were followed up clinically and histologically at regular intervals. Overall, in an intention-to-treat analysis, 15 patients had normal alanine aminotransferase levels (biochemical end-treatment response [ETR], 83%), and 8 patients were also hepatitis C virus RNA negative in serum (virological ETR, 44%) at the end of combined treatment. At last follow-up after the completion of combined therapy (median, 32 months; range, 18 to 73 months), 13 patients were biochemical responders (biochemical long term-sustained response [LT-SR], 72%), and 5 patients also maintained viral clearance (virological LT-SR, 27%). Comparison of liver biopsy specimens before and after 12 months of combined therapy showed improvement in grading scores of at least two points in the majority of the patients (73%). Notably, a trend toward fibrotic progression was only noted in nonresponders. Regarding side effects, despite the low dose of ribavirn, almost half the patients developed hemolytic anemia requiring dose reductions. In addition, long-term ribavirin monotherapy was not associated with iron accumulation. We conclude that combined therapy with low-dose ribavirin followed by long-term ribavirin monotherapy can be recommended because it favorably modifies the natural history of recurrent hepatitis C in most patients and possibly halts histological disease progression without causing iron accumulation.
- Subjects :
- Administration, Oral
Adult
Aged
Cohort Studies
Dose-Response Relationship, Drug
Drug Administration Schedule
Drug Therapy, Combination
Female
Follow-Up Studies
Humans
Injections, Subcutaneous
Liver Cirrhosis surgery
Liver Cirrhosis virology
Liver Transplantation methods
Male
Middle Aged
Postoperative Complications drug therapy
Recurrence
Statistics, Nonparametric
Treatment Outcome
Antiviral Agents administration & dosage
Hepatitis C, Chronic diagnosis
Hepatitis C, Chronic drug therapy
Interferon-alpha administration & dosage
Liver Transplantation adverse effects
Ribavirin administration & dosage
Subjects
Details
- Language :
- English
- ISSN :
- 1527-6465
- Volume :
- 7
- Issue :
- 10
- Database :
- MEDLINE
- Journal :
- Liver transplantation : official publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society
- Publication Type :
- Academic Journal
- Accession number :
- 11679985
- Full Text :
- https://doi.org/10.1053/jlts.2001.27871