ORLANDO, FLA. — Antiviral therapy for recurrent hepatitis C infection in patients who have had orthotopic liver transplantation promotes a sustained virologic response, but also appears to contribute to a substantial number of allograft failures, Don C. Rockey, M.D., reported at the annual meeting of the American College of Gastroenterology.
Of 49 patients who had liver transplantation for chronic hepatitis C virus (HCV) infection between 1991 and 2004 and who received antiviral therapy with interferon and ribavirin for recurrent HCV, 12 had a sustained virologic response, 18 had a measurable improvement in liver test results, and 7 developed acute and/or ductopenic allograft rejection during therapy.
In each case, the development of abnormalities was associated with elimination of HCV RNA from the serum, said Dr. Rockey of Duke University, Durham, N.C. Three patients died from complications associated with profound cholestasis.
Other reports of allograft rejection during antiviral therapy in transplant patients have raised questions about the appropriateness of such treatment. Although aggressive anti-HCV therapy led to a sustained virologic response in nearly a third of the transplant patients with recurrent HCV who did not experience allograft rejection, there is an apparent tradeoff in terms of an increased risk of rejection in some patients, Dr. Rockey noted.
Large randomized, controlled studies are needed to better assess the effects of antiviral therapy on liver transplant patients, he concluded.