Extending treatment after liver transplant may benefit patients with hepatitis C recurrence

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Extending hepatitis C treatment for liver transplant patients beyond current practice results in high rates of clearance of the hepatitis C virus from the blood, as well as a low rate of relapse, according to a Henry Ford Hospital study. "We found that patients who achieved a sustained virological response were more likely to have had extended treatment," says Kimberly Brown, M.D., Division head of Gastroenterology at Henry Ford Hospital and senior author of the study.

"In addition, prolonging treatment for 52 weeks after patients were virus negative, resulted in a relapse rate of only 8 percent." This is in contrast to typical relapse rates of 30-35 percent in non transplant patients treated with standard therapy.

Study results will be presented during an oral presentation Oct. 31 at the American Association for the Study of Liver Diseases' Annual Meeting in Boston.

The study looked at 241 consecutive liver transplant patients from 1999-2006. Patients were offered treatment if they tested positive hepatitis C, had recurrent hepatitis C with at least Stage I fibrosis on biopsy, and stable immunosuppression for a minimum of three months. Patients received either non-pegylated interferon tiw or pegylated interferon weekly in combination with ribavirin.

Of the study patients with hepatitis C, 66 were eligible for treatment, and 22 achieved sustained virological response. Only two patients (8 percent) relapsed.

After week 24 of treatment, 35 percent of patients who achieved a sustained virologic response became virus negative.

"These results call into question previous studies which suggested 'stop rules' at weeks 12 and 24 when there is no response to inferferon and ribravirin," says Dr. Brown. "Our results suggest that even if patients are positive at week 24, there is still a 35 percent chance that they can achieve sustained viral clearance. We think this may be beneficial to extend treatment beyond the standard 48 weeks total."

According to the U.S. Department of Health & Human Services, more than 16,000 liver transplants were performed last year and there are currently almost 18,000 Americans on the liver transplant list.