Limited Benefit of Biochemical Response to Combination Therapy for Patients With Recurrent Hepatitis C After Living-Donor Liver Transplantation

Abstract

Effective management of patients with recurrent hepatitis C after liver transplantation has not been established. In this study, we tested the significance of biochemical response (BR) as well as sustained virological response (SVR) to combination therapy with interferon alpha-2b and ribavirin for recurrent hepatitis C after living-donor liver transplantation. Forty patients received therapy and formed 3 groups by response: SVR (n=14, 35%) and BR (n=14, 35%), defined when serum alanine aminotransferase normalized during therapy in non-SVR patients, and no response (NR; n=12, 30%). Histological changes of these groups after the combination therapy were investigated. Activity grade of liver histology improved significantly in patients with an SVR at 1 and at 2-4 years after the initiation of treatment, showing difference from the BR and NR groups in which the activity was not improved by interferon therapy. Fibrosis deteriorated significantly in both the BR and the NR groups at two to four years. The rates of patients whose fibrosis stage deteriorated to stage F2 or more were significantly greater in the BR and NR groups than in the SVR group. Fibrosis decreased or remained stable in five of eight patients (63%) with an SVR at two to four years, whereas it increased in 12 of 15 patients (80%) with a BR or NR. Patients with an SVR showed histological improvement, but the benefit of a BR for non-SVR patients to improve the activity grade or to inhibit the progression of fibrosis was limited.