Maintenance ribavirin monotherapy delays fibrosis progression in liver transplant recipients with recurrent hepatitis C at high risk of progression
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.
aHepatology Unit, University of Rome “Tor Vergata”, Via Montpellier, 1, 00133 Rome, Italy
bLiver Transplant Unit, University of Rome “Tor Vergata”, Via Montpellier, 1, 00133 Rome, Italy
cDepartment of Pathological Anatomy, 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.
ABSTRACT