Treatment To Prevent Hepatitis C Recurrence After Liver Transplantation
A clinical trial conducted at U.S. liver transplant centers has shown that pre-treatment of patients infected with hepatitis C, using antiviral therapy to suppress the viral infection, can prevent recurrence of the infection once patients are transplanted with a healthy donor liver. Chronic hepatitis C is one of the major reasons for adult liver transplantation. Adult-to-adult living donor liver transplantation—removal of part of a living adult’s healthy liver for transplantation into another adult with liver disease—is one option for patients whose livers have been damaged by hepatitis C. However, in patients who still have hepatitis C virus (HCV) circulating in their blood at the time of transplantation, the infection will inevitably recur and threaten the health of the transplanted organ, whether from a living or cadaveric donor. Previous small studies had suggested one strategy to prevent this is with treatment prior to transplant using antiviral drugs against HCV—pegylated interferon and ribavirin—to suppress viral levels in the blood. But this antiviral treatment is less effective in individuals with some types of the virus and can cause side effects.
Researchers at seven U.S. transplant centers participating in the Adult-to-Adult Living Donor Liver Transplantation Cohort Study (A2ALL) performed the irst randomized clinical trial assessing the efficacy and safety of antiviral therapy pretreatment to prevent hepatitis C recurrence after liver transplantation. Patients infected with some of the HCV types prevalent in the United States were recruited into treatment and control groups. Prior to transplant, the treatment groups were started on a low dose of peginterferon and ribavirin that steadily increased over the course of treatment, which lasted up to a maximum of 48 weeks. The researchers measured viral RNA levels to determine whether the virus was responding to treatment; an undetectable level of viral RNA in the blood after several weeks of treatment, before then after transplant, represented a response. They found that patients who were treated prior to transplant for at least 16 weeks were more likely to have undetectable levels of HCV after transplant than those with shorter treatments. Overall, a similar number of total adverse events occurred in the treated and control groups, although the number of adverse events per person and also incidence of the particular adverse event of bacterial infection were higher in the treated groups. This study provides clinical evidence that antiviral therapy prior to a liver transplant can prevent hepatitis C recurrence in some patients. This finding is particularly applicable to patients who are better able to tolerate an extended course of antiviral therapy and its potential side effects.