HOME
Return to Table of Contents
VARIATION IN RESPONSE TO PEGYLATED INTERFERON AND RIBAVIRIN THERAPY BETWEEN DIFFERENT GENOTYPES IN PATIENTS WITH RECURRENT HEPATITIS C AFTER LIVER TRANSPLANTATION
A Lau, M Levstik
Multi-Organ Transplant Program, London Health Sciences Centre, London, Ontario
BACKGROUND: Recurrent hepatitis C (HCV) after orthotopic liver transplantation (OLT) is universal and often more aggressive.
OBJECTIVE: To evaluate the response to pegylated interferon (PEG-IFN) and ribavirin (RIB) in the treatment of post-OLT HCV recurrence with genotype 1 compared to genotype 2 or 3.
METHODS: Twenty-one HCV patients underwent OLT between 1997 and 2005 with recurrent HCV were treated with PEG-IFN and RIB,15 of them with genotype 1 and 6 with genotype 2 or 3. Dose, duration and tolerance to medications, sustained viral response (SVR), and time between OLT and onset of treatment were compared between the two groups.
RESULTS: Patients with genotype 1 seemed to be less tolerant to PEG-IFN and RIB as compared to genotype 2 or 3. Only 43% patients with genotype 1 completed the treatment course (48 weeks) as compared to 67% with genotype 2 or 3 (24 weeks). Average dose of PEG-IFN and RIB were similar between the 2 groups, with mean PEG-IFN dose 1.7ug/kg/wk (range 0.52 to 3.33 ug/kg/wk) and mean RIB dose 870 mg/d, (range 200 to 1200 mg/d). Overall SVR was 26%, with significant difference between the genotype 1 (6%) and genotype 2 or 3 (83%). The only case of SVR from genotype 1 was interestingly from a patient with living donor transplantation. In subgroup analysis, 3 patients received early HCV treatment (within 6 months after OLT) as compared to 18 patients treated at least 6 months after OLT. Early treatment group had lower rate of treatment completion (33% vs 50%) and lower SVR (0% vs 29%) compared to the patients who received treatment at least 6 months after OLT, with all genotypes combined.
CONCLUSION: Similar to non-OLT HCV patients, genotype 2 or 3 seemed to correlate with a higher SVR and better tolerance to PEG-IFN and RIB treatment as compared to genotype 1 in post-OLT recurrent HCV patients. Our study also suggested that starting PEG-IFN and RIB at least 6 months after OLT might have a better outcome in terms of SVR and compliance to antiviral treatment.