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LONG TERM RESULTS AFTER THERAPY WITH PEGYLATED INTERFERON ALPHA 2A (PEGASYS) IN HCV POSITIVE LIVER TRANSPLANT RECIPIENTS
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Marcus Bahra, Charite - Campus Virchow, Dep. of Surgery, Berlin, Germany; Ulf P. Neumann, Charite - Campus Virchow, Dep. of Surgery, Berlin, Germany;
Dietmar Jacob, Charite - Campus Virchow, Dep. of Surgery, 13353 Berlin, Germany; Jan M. Langrehr, Charite - Campus Virchow, Dep. of Surgery, Berlin, Germany; Ruth Neuhaus, Charite, Campus - Virchow, Dept. of Surgery, Berlin, Germany; Peter Neuhaus, Charite - Campus Virchow, Dept. of Surgery, Berlin, Germany
Background: Hepatitis C reinfection after orthotopic liver transplantation (OLT) is a major cause of graft loss in HCV positive liver graft recipients. We evaluated the efficacy and safety of pegylated interferon alfa-2a and ribavirin treatment for recurrent HCV after OLT.
Methods: 60 patients with recurrent HCV received peginterferon alpha 2a (0.5 - 1.5g/kg per week) and ribavirin (400- 800mg/ day) for a minimum of 48 weeks. Including criteria were: positive test for anti-HCV and HCV RNA by RT-PCR, 2-3 times elevated serum alanine aminotransferase (ALT) levels before initiation of treatment, and a liver biopsy showing recurrent hepatitis C.
Endpoint of the study was defined by undetectable serum HCV-RNA 6 months after end of treatment (sustained virologic response). Furthermore protocol biopsies were accomplished to evaluate the influence of pegylated interferon on fibrosis progression. Mean follow-up was 96 weeks.
Results:
28/60 patients became HCV-RNA-negative after 48 weeks of treatment (46,6%). Sustained virologic response (SVR) was achieved in 20/60 (33,3%) patients.
Liver specimen showed increase of fibrosis from 0.8 to 1.25 (Metavir-Score). Side effects like neutropenia (51,6%) and anemia (38.3%) were treated with G-CSF, erythropoietine, and dose reduction of peginterferon and ribavirin. 12/20 patients with SVR received supportive treatment with growth hormones (4/20 G-CSF alone, 2/20 erythropoietine alone and 6/20 G-CSF and erythropoietine). In five patients complete cessation of the pegylated interferon/ribavirin treatment was indispensable (8.3%).
Conclusion: The use of peginterferon alpha 2a is safe and effective in patients with hepatitis C reinfection after OLT. The yearly fibrosis progression rate during interferon therapy tended to be decelerated. Treatment of neutropenia and anemia helped to maintain antiviral therapy and seemed to play a role to increase SVR rates.
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