RESUMO
Pakistan has a very high HCV prevalence[1] with majority being genotype 3. A high number of patients with cirrhosis undergo liver transplantation. HCV recurrence following transplant is universal[2]. Interferon free therapy has recently become available and preliminary studies show 70% SVR in post transplant patients[3]. Since genotype 3 has a high response to pegylated Interferon 3, it remains a competitive agent
Aims and Methods: The aim of this study was to determine the efficacy of pegylated interferon plus ribavirin in the treatment of recurrent hepatitis C following liver transplantation. 15 patients with recurrent hepatitis C following liver transplantation were included in the study, 13 males and 2 females. Mean age was 52 years. 13 had genotype 3 disease, one genotype 2 and one genotype 1.11 were living donor and 4 were cadaveric grafts. 13 were on tacrolimus and MMF, one on tacrolimus alone and one on cyclosporine and MMF. 6 patients were treated within 2 years of transplant and remaining 9 were treated 3-5 years after transplant. Liver biopsy was done prior to therapy in 6 patients. All patients received pegylated interferon a2a 180 g weekly plus ribavirin 15mg/kg daily for 48 weeks
Results: 14 out of 15 patients [93.3%] achieved SVR. This included all 13 Genotype 3 patients [100%] and the single genotype 2 patient. One patient, genotype 1, was nonresponder to treatment. Treatment was stopped at 22 and 36 weeks in 2 patients due to anaemia. Both achieved SVR. 11 patients were administered erythropoietin for anemia. 7 patients required ribavirin dose reduction for anemia, and achieved SVR despite dose reduction
Conclusion: Pegylated interferon and ribavirin is an extremely effective combination for treatment of patients with recurrent genotype 3 hepatitis C after liver transplantation. The main side effect is anaemia, which can be managed with erythropoietin supplementation and ribavirin dose reduction without any reduction in response rate