Interferon Treatment Improves Survival among Liver Transplant Recipients with Recurrent Hepatitis C

Hepatitis C in the liver allograft recipient has an aggressive course. A significant proportion of such recipients develop graft fibrosis and cirrhosis within five years of transplantation. Treatment efficacy with standard or pegylated interferon and ribavirin is suboptimal compared to the immunocompetent individuals. However, the effect of such therapy on graft and patient survival remains unknown. Objectives: To determine the efficacy of interferon based therapies in liver transplantation recipients with recurrent hepatitis C, and to determine the effect of interferon treatment on graft and patient survival. Methods: We retrospectively analyzed 823 hepatitis C patients, who underwent liver transplantation at Thomas E Starzl Transplantation Institute, University of Pittsburgh between January 1992 and April 2006. Two hundred and sixty four patients received either interferon (all kinds) monotherapy, or combination therapy. The primary end point was graft failure and death. Results: Both treated and untreated groups were similar in clinical characteristics at the time of transplantation. In treatment group, 77% received prednisone based immunosuppression as compared to 75% in no treatment group. 57% of patients in treatment group had HCV RNA >1 million units/ml after transplantation. Patients were categorized into four groups; no treatment (n=440), ? 24 weeks of treatment (n=38), 25-48 weeks of treatment (n=64) and >48 weeks of treatment (162). Total bilirubin > 2 at 6 and 12 months and an AST/ALT ratio of >1 at 6 month of transplantation are independently associated with poor patient survival. Patients who received treatment for >48 weeks have significantly improved survival independent of sustained viral response (HR 0.33, p=<0.001). Conclusion: Among liver transplant recipients with recurrent hepatitis C, treatment with any interferon with or without ribavirin for >48 weeks is significantly associated with improved patient survival regardless of viral response. Prospective trials are indicated to confirm these findings.