Skip to main content

Advertisement

SpringerLink
Log in

Treatment of hepatitis C virus in the liver transplant recipient

  • Published:
Current Treatment Options in Gastroenterology Aims and scope Submit manuscript

Opinion statement

Significant necroinflammatory and/or fibrotic histologic changes should prompt consideration of antiviral therapy in liver transplant recipients with chronic hepatitis C. Depending on the patient, consideration of lower-dose pegylated interferon initially, with an increase to standard doses over the course of 1 month, may improve patient compliance and tolerance. The use of growth factors to prevent anemia and leukopenia is encouraged. Liver transplant recipients should be treated for at least 1 year, until data are available on optimal duration of therapy in non-genotype 1 patients in this patient subpopulation.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References and Recommended Reading

  1. Kim WR: The burden of hepatitis C in the United States. Hepatology 2002, 36(5 suppl 1):S30–34.

    Article  PubMed  Google Scholar 

  2. Willems M, Metselaar HJ, Tilanus HW, et al.: Liver transplantation and hepatitis C. Transplant Int 2002, 15:61–72.

    Article  CAS  Google Scholar 

  3. Sheiner PA, Boros P, Klion FM, et al.: The efficacy of prophylactic interferon alfa-2b in preventing recurrent hepatitis C after liver transplantation. Hepatology 1998, 28:831–838.

    Article  PubMed  CAS  Google Scholar 

  4. Charlton M, Seaberg E, Wiesner R, et al.: Predictors of patient and graft survival following liver transplantation for hepatitis C. Hepatology 1998, 28:823–830.

    Article  PubMed  CAS  Google Scholar 

  5. Berenguer M, Prieto M, Cordoba J, et al.: Early development of chronic active hepatitis in recurrent hepatitis C virus infection after liver transplantation: association with treatment of rejection. J Hepatol 1998, 28:756–763.

    Article  PubMed  CAS  Google Scholar 

  6. Platz KP, Mueller AR, Berg T, et al.: Searching for the optimal management of hepatitis C patients after liver transplantation. Transplant Int 1998, 11(suppl 1):S209–211.

    Article  Google Scholar 

  7. Rosen HR, Shackleton CR, Higa L, et al.: Use of OKT3 is associated with early and severe recurrence of hepatitis C after liver transplantation. Am J Gastroenterol 1997, 92:1453–1457.

    PubMed  CAS  Google Scholar 

  8. Crippin JS, McCashland T, Terrault N, et al.: A pilot study of the tolerability and efficacy of antiviral therapy in hepatitis C virus-infected patients awaiting liver transplantation. Liver Transplant 2002, 8:350–355.

    Article  Google Scholar 

  9. Cotler SJ, Ganger DR, Kaur S, et al.: Daily interferon therapy for hepatitis C virus infection in liver transplant recipients. Transplantation 2001, 71:261–266.

    Article  PubMed  CAS  Google Scholar 

  10. Samuel D, Bizollon T, Feray C, et al.: Interferon-alpha 2b plus ribavirin in patients with chronic hepatitis C after liver transplantation: a randomized study. Gastroenterology 2003, 124:642–650. This randomized study assessed the safety and efficacy of interferon and ribavirin for recurrent hepatitis C after liver transplantation. Twenty-eight patients were treated and 24 received placebo. Treated patients achieved a 21% sustained virologic response; however, 43% discontinued therapy due to adverse events.

    Article  PubMed  CAS  Google Scholar 

  11. Shakil AO, McGuire B, Crippin J, et al.: A pilot study of interferon alfa and ribavirin combination in liver transplant recipients with recurrent hepatitis C. Hepatology 2002, 36:1253–1258. This study evaluated the efficacy of 3 million U of interferon alfa-2b subcutaneously three times weekly with 800 mg/d of ribavirin by mouth for 48 weeks followed by ribavirin only for 24 additional weeks in transplant recipients with recurrent HCV. Only 5% of patients had a sustained virologic response and 42% withdrew from the study due to adverse events.

    Article  PubMed  CAS  Google Scholar 

  12. Narayanan Menon KV, Poterucha JJ, El-Amin OM, et al.: Treatment of posttransplantation recurrence of hepatitis C with interferon and ribavirin: lessons on tolerability and efficacy. Liver Transplant 2002, 8:623–629. This study evaluated 26 transplant recipients with recurrent HCV. Subjects received 3 million U of interferon alfa-2b three times weekly with 800 to 1000 mg/d of ribavirin. Treatment induced a 23% sustained virologic response rate. However, as in other studies, the majority of patients required dose modifications due to adverse events.

    Article  Google Scholar 

  13. FirpiRJ, Abdelmalek MF, Soldevila-Pico C, et al.: Combination of interferon alfa-2b and ribavirin in liver transplant recipients with histological recurrent hepatitis C. Liver Transplant 2002, 8:1000–1006. In this study, patients were treated with escalating doses of interferon and ribavirin up to 3 million U subcutaneously three times weekly and 1000 mg/d, respectively, for 48 weeks. Patients achieved a sustained virologic response rate of 30%. However, most patients required dose reduction and did not reach the target dose or duration of therapy.

    Article  Google Scholar 

  14. Vargas HE: Combination pegylated interferon alpha-2b and ribavirin in transplant patients with recurrent hepatitis C infection: a preliminary report [abstract]. Hepatology 2001, 34(4 pt 2).

  15. Manzarbeitia C: 40 KDA peginterferon alfa-2a (Pegasys) as a prophylaxis against hepatitis C infection recurrence after liver transplantation: preliminary reuslts of a randomized multicenter trial [abstract]. Hepatology 2001, 34(4 pt 2).

  16. Ferenci P: 40 KDA Peginterferon alfa-2a (Pegasys) in post-liver transplant recipients with established recurrent hepatitis C: preliminary results of a randomized multicenter trial [abstract]. Hepatology 2001, 34(4 pt 2).

  17. Schluger LK, Sheiner PA, Thung SN, et al.: Severe recurrent cholestatic hepatitis C following orthotopic liver transplantation. Hepatology 1996, 23:971–976.

    Article  PubMed  CAS  Google Scholar 

  18. Dickson RC, Caldwell SH, Ishitani MB, et al.: Clinical and histologic patterns of early graft failure due to recurrent hepatitis C in four patients after liver transplantation. Transplantation 1996, 61:701–705.

    Article  PubMed  CAS  Google Scholar 

  19. Gopal DV, Rosen HR: Duration of antiviral therapy for cholestatic HCV recurrence may need to be indefinite. Liver Transplant 2003, 9:348–353.

    Article  Google Scholar 

  20. Physician’s Desk Reference, edn 57, vol 1. Montvale, NJ: Medical Economics; 2003.

  21. Lacy CF, Fuller R, Matthew A, et al.: Drug Information. Hudson, OH: Lexi-Comp; 2001.

    Google Scholar 

  22. Fried MW: Side effects of therapy of hepatitis C and their management. Hepatology, 2002, 36(5 suppl 1):S237-S244.

    Article  PubMed  Google Scholar 

  23. Drug Topics Red Book, edn 106. Montvale, NJ: Medical Economics; 2002.

  24. United Network for Organ Sharing. http://www.unos.com. Accessed July 17, 2003.

  25. Berenguer M, Prieto M, Palau A, et al.: Severe recurrent hepatitis C after liver retransplantation for hepatitis C virus-related graft cirrhosis. Liver Transplant 2003, 9:228–235.

    Article  Google Scholar 

  26. Rosen HR, Martin P: Hepatitis C in patients undergoing liver retransplantation. Transplantation 1998, 66:1612–1616.

    Article  PubMed  CAS  Google Scholar 

  27. Jacobs BP, Dennehy C, Ramirez G, et al.: Milk thistle for the treatment of liver disease: a systematic review and meta-analysis. Am J Med 2002, 113:506–515.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Division of Gastroenterology, Washington University School of Medicine, 660 South Euclid, Campus Box 8124, 63110, St. Louis, MO, USA

    Lafaine Grant MD & Jeffrey S. Crippin MD

Authors
  1. Lafaine Grant MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jeffrey S. Crippin MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Grant, L., Crippin, J.S. Treatment of hepatitis C virus in the liver transplant recipient. Curr Treat Options Gastro 6, 517–522 (2003). https://doi.org/10.1007/s11938-003-0054-1

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11938-003-0054-1

Keywords

Search

Navigation