Maintenance ribavirin monotherapy delays fibrosis progression in liver transplant recipients with recurrent hepatitis C at high risk of progression

Lionetti, Raffaella; Tisone, Giuseppe; Palmieri, Giampiero; Almerighi, Cristiana; Anselmo, Alessandra; Tariciotti, Laura; Lenci, Ilaria; De Luca, Linda; Monaco, Andrea; Angelico, Mario

doi:10.1016/j.dld.2009.08.008

« Previous Next »Digestive and Liver Disease
Volume 42, Issue 4 , Pages 297-303, April 2010

Maintenance ribavirin monotherapy delays fibrosis progression in liver transplant recipients with recurrent hepatitis C at high risk of progression

Raffaella Lionetti
- Hepatology Unit, University of Rome “Tor Vergata”, Via Montpellier, 1, 00133 Rome, Italy
Giuseppe Tisone
- Liver Transplant Unit, University of Rome “Tor Vergata”, Via Montpellier, 1, 00133 Rome, Italy
Giampiero Palmieri
- Department of Pathological Anatomy, University of Rome “Tor Vergata”, Via Montpellier, 1 00133 Rome, Italy
Cristiana Almerighi
- Hepatology Unit, University of Rome “Tor Vergata”, Via Montpellier, 1, 00133 Rome, Italy
Alessandra Anselmo
- Liver Transplant Unit, University of Rome “Tor Vergata”, Via Montpellier, 1, 00133 Rome, Italy
Laura Tariciotti
- Liver Transplant Unit, University of Rome “Tor Vergata”, Via Montpellier, 1, 00133 Rome, Italy
Ilaria Lenci
- Hepatology Unit, University of Rome “Tor Vergata”, Via Montpellier, 1, 00133 Rome, Italy
Linda De Luca
- Liver Transplant Unit, University of Rome “Tor Vergata”, Via Montpellier, 1, 00133 Rome, Italy
Andrea Monaco
- Hepatology Unit, University of Rome “Tor Vergata”, Via Montpellier, 1, 00133 Rome, Italy
Mario Angelico
- Hepatology Unit, University of Rome “Tor Vergata”, Via Montpellier, 1, 00133 Rome, Italy
- Corresponding author at: Cattedra di Gastroenterologia, Dipartimento di Medicina Interna, Università di Roma Tor Vergata, Via Montpellier, 1, 00133 Rome, Italy. Tel.: +39 06 7259 6803; fax: +39 06 7259 6803.

Received 24 June 2009; accepted 31 August 2009. published online 09 October 2009.

Abstract

Background

Fibrosis in liver transplant recipients with recurrent HCV is fast, yet, different patterns of progression are recognized.

Aims

To investigate histological findings associated with maintenance ribavirin monotherapy in patients with recurrent HCV transplanted ≥4 years earlier.

Methods

14 recipients at high risk of progression (fibrosis progression rate >0.33 units/year and/or persistently elevated ALT) were assigned to receive ribavirin for 3 years. 11 patients at lower risk of progression (FPR ≤0.33 units/year and normal ALT) as controls. Biopsies were obtained yearly since transplant and 7 consecutive biopsies were evaluated.

Results

Improved necroinflammation (reduction ≥2 grading) was observed in 7 treated with ribavirin and 3 untreated patients, while 1 and 3 patients worsened respectively. Fibrosis improved (reduction >1 staging) in 2 ribavirin-treated patients, unchanged in 10 and worsened (increase ≥1 staging) in 2. Fibrosis progression decreased from 0.48±0.27 observed during the 3-year pre-treatment period to 0.04±0.31 units/year (p=0.003) during the 3 years of ribavirin. Among untreated fibrosis remained unchanged in 1 and worsened in 10 (p<0.001), yearly fibrosis progression rate increasing from 0.15±0.17 units/year to 0.42±0.39 units/year (p=0.10).

Conclusions

Maintenance ribavirin monotherapy delays fibrosis progression in high risk patients, offering an alternative strategy for those failing to respond to conventional treatment.

Keywords: Disease recurrence, Grading, Graft, Immunosuppression, Staging