Preemptive Therapy With Pegylated Interferon Alpha-2b and Ribavirin After Liver Transplantation for Hepatitis C Cirrhosis M. Castedal, M. Felldin, L. Bäckman, M. Olausson, and S. Friman ABSTRACT We present our results of preemptive treatment with pegylated interferon and ribavirin after liver transplantation for hepatitis C cirrhosis. Patients. Between September 2001 and August 2002, four patients were started on combination therapy with pegylated interferon-alpha-2b (1g/kg weekly) and ribavirin (400 –1000 mg/d) 3 to 4 weeks’ posttransplant. Treatment was continued for 6 (genotype 3a, 2 patients) or 12 (genotype 1b, 2 patients) months. Virologic and biochemical responses as well as side effects were evaluated. Results. Two patients (genotype 3a) became HCV (hepatitis C virus)-RNA negative after 3 months of therapy and are persistently negative 20 and 14 months after end of therapy. One patient (genotype 1b) became HCV-RNA negative 6 months after start of treatment, but therapy had to be withdrawn after 9 months owing to fatigue and suspicion of angina pectoris. One patient who was later retransplanted because of hepatic artery thrombosis discontinued therapy after 2.5 months owing to anemia, leukopenia, and no signs of HCV-RNA reduction. Interestingly, two of the responders were nonresponders prior to liver transplant. Median ALT levels at start of therapy were 98 U/L (r = 60–126) and 12 months later 40 U/L (r = 24 –58) (n = 4). No rejection episode was detected. Conclusion. In patients liver-transplanted due to HCV-cirrhosis, combination therapy with pegylated interferon and ribavirin can be effective and safe in the early posttransplant period, thus preventing recurrent hepatitis C. C URRENTLY, cirrhosis due to hepatitis C virus (HCV) infection is one of the two most common indications for orthotopic liver transplantation (OLT) in Europe. 1 It also is becoming increasingly common in the Scandinavian countries. Moreover, HCV viremia is almost universal after OLT; approximately 50% of patients develop histological evidence of recurrence within the first year. Twenty percent of patients develop cirrhosis after 5 years and 10% develop fibrosing cholestatic hepatitis leading to cirrhosis within 1 year after OLT. 2,3 Recently, the median time from hepatitis C recurrence to manifest cirrhosis has been calculated to be 10 years. 2 The last years we have seen alarming data of severe hepatitis C recurrence from the group in Valencia. They could clearly show that HCV-related disease progres- sion was accelerated in immunocompromised compared to immunocompetent patients, with an increase in severity in patients who have recently undergone liver transplanta- tion. 2,4 This has been a growing concern during the last years, and one possible explanation to this observation is the wider use of marginal and older donors. There is today no consensus on the role of prophylactic antiviral therapy to prevent HCV recurrence after OLT. However, once recurrent hepatitis C has occurred, combi- nation therapy with pegylated interferon and ribavirin is usually the chosen therapy. The aim of the present study was to evaluate the efficacy and safety of preemptive From the Department of Transplantation and Liver Surgery, Sahlgrenska University Hospital, Göteborg, Sweden. This work was supported by the Swedish Medical Research Council. Address reprint requests to Styrbjorn Friman, MD, Department of Transplantation and Liver Surgery, Sahlgrenska University Hos- pital, S-413 45, Göteborg, Sweden. E-mail: styrbjorn.friman@ surgery.gu.se © 2005 by Elsevier Inc. All rights reserved. 0041-1345/05/$–see front matter 360 Park Avenue South, New York, NY 10010-1710 doi:10.1016/j.transproceed.2005.09.018 Transplantation Proceedings, 37, 3313–3314 (2005) 3313