Introduction Recurrence of hepatitis C (HCV) post liver transplantation is universal and may follow a rapidly progressive course, which results in poorer long-term graft survival rates compared with other liver diseases. Sustained virological response (SVR) after anti-viral treatment has recently been shown to significantly improve liver histology and long-term survival1.
Aim To describe our experience of the treatment of recurrent HCV post liver transplantation.
Method Retrospective case-note review of all patients transplanted for HCV.
Results 41 patients were transplanted in Newcastle for chronic HCV (10 had HCC) between 1993 and 2008. Up to 2002 our 5 year survival for patients with HCV was 45%. In order to try and improve this antiviral therapy was offered to patients from 2002. 15 patients (median age 50, range 38–68; 11 (73%) male) received individualised treatment with pegylated interferon (PEG-IFN) +/- ribavirin (RBV). All had liver biopsy showing recurrent HCV, 3 had cirrhosis and 1 had cholestatic hepatitis. 10 (66%) patients were infected with HCV genotype 1 (G1) and 5 with genotype 3 (G3). 4 patients (27%) achieved SVR following treatment (4 G3 and 1 G1) and 1 patient is currently on treatment and was HCV RNA negative at 12 weeks (G3). All patients who achieved SVR had =48 weeks treatment with PEG-IFN+RBV and had mild hepatic fibrosis. Of the four patients who had an SVR, 2 were taking ciclosporin and 2 tacrolimus. Adverse events were common and led to cessation of therapy in 6 patients (3 pancytopaenia, 1 refractory anaemia, 1 myocardial infarction, 1 hepatic decompensation). All cirrhotic patients stopped treatment due to adverse events. Severe anaemia was very common and 5 patients were treated with erythropoietin (2 had SVR).
Conclusion Treatment of recurrent HCV post-liver transplantation can be successful in selected patients, particularly patients with HCV G3 with mild hepatic fibrosis. This experience has led us to discuss anti-viral therapy at 6 months post liver transplant.
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