TSI Lyburn, C Sherlock¹, EM Yoshida, N Partovi², UP Steinbrecher

Department of Medicine, ¹Microbiology, ²Pharmacy, University of British Columbia and BC Transplant Society, Vancouver, British Columbia, Canada

Background: Hepatitis C virus (HCV) re-infection occurs universally after  OLT for HCV-related cirrhosis and leads to graft hepatitis in > 50%.  Recent studies have suggested a beneficial effect of MMF therapy on HCV replication and aspartate aminotransferase (AST) levels.

Aim: To test the hypothesis that MMF suppresses HCV replication and may reduce post-OLT allograft re-infection.

Methods:  5 patients with biopsy proven HCV allograft re-infection were initiated on MMF at a dose of 1-3 g/day. Quantitative HCV RNA by PCR was determined immediately prior to this and at 4-8 week intervals up to 32 weeks.  Serum AST was measured concurrently.

Results: Of the five patients, one patient died of decompensated cirrhosis two weeks after initiation. No post-MMF HCV RNA titres were drawn.  Baseline HCV RNA titres were not available on a second patient who died of HCV-associated fibrosing cholestatic hepatitis 6 weeks after MMF was commenced.  Of the remaining patients, an initial, but not statistically significant, reduction was observed within 8 weeks (p=0.115).  Subsequent titres increased with fluctuations.  There was no correlation with AST levels.  One patient developed decompensated portal hypertension 10 months post-MMF.

Conclusion:  Although there was a trend to early reduction in viral load post-MMF this was not sustained and does not have any clinical effect. Further studies in combination with interferon are needed.

Supported by a grant from Roche-Canada.

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