RETRANSPLANTATION FOR HEPATITIS C-RELATED CIRRHOSIS UNDER LONG-TERM PEGYLATED INTERFERON THERAPY

Abstract

P535 Aims: The objetive of the present study is to review our experience with HCV-infected transplant recipient undergoing re-OLT for HCV graft cirrhosis, and receiving pegylated interferon and ribavirin on a prophylactic basis. Methods: Between May 1994, and March 2003 a total of 446 patients underwent OLT at our institution. 132 of these patients underwent transplantation for cirrhosis secondary to chronic HCV infection. Five consecutive patients undergoing liver retransplantation for HCV-related cirrhosis were included in the study. Protocol liver biopsies were performed yearly after retransplantation: The grade activitiy and stage fibrosis was determined by combining the histological activity index (HAI) scores for portal inflammation (0-4), lobular degeneration and necrosis (0-4), and periportal necrosis (0-10). All patients received tacrolimus, mofetil mycophenolate (MMF) and a monoclonal antibody anti-interleukin-2-receptor (Daclizumab) Prophylactic treatment with pegylated interferon-α-2b (PEG-intron) in combination with ribavirin was initiated in every patient Characteristics of Patients at Transplantation.FigureResults: After retransplantation, all five patients are alive with stable graft function after a median follow-up of 26 months (range, 15 to 33 months). No episodes of rejection were noted, and steroids were not necessary in any patient. Six months after retransplantation maintenance immunosuppression was tacrolimus monotherapy in all patients. After 20 months of treatment, none of the patients had cleared HCV RNA by PCR. However, mean serum levels declined significantly when compared with pre-retransplantation levels. For the entire group, there was a statistically significant decrease in serum biochemical indices assessed at 6 and 12 months into therapy when compared with pre-retransplantation levels (ALT at one year, 215 versus 64 IU/L; p<0.05) Our patients were highly selected according to the model proposed by Rosen, and although all five patients had developed aggressive recurrent disease leading to cirrhosis between two years after OLT, they were re-transplanted early after the first hepatic decompensation (median time, 6 months), before the development of infectious and renal complications In our study, we examine the efficacy of a Interleukin-2 receptor monoclonal antibody in combination with MMF and tacrolimus, without steroids. This strategy has been associated with a extremely low rate of acute cellular rejection episodes requiring steroids, one of the variables implicated in the outcome of posttransplant hepatitis C The most important, is that after retransplantation, all five patients are alive with stable graft function after a median follow-up of 26 months, which is encouraging compared to the severe and progressive disease observed after the initial transplantation. Conclusions: Although this study is limited by the small sample size and limited follow-up, our data suggest that the severity of HCV-related disease after retransplantation does not seem to predict that observed after the initial OLT. Better results can be obtained in selected patients, even with aggressive disease after the first OLT, receiving long-term combined therapy with pegylated interferon and ribavirin.