Treatment for HepC after transplant

I'm a 54 yr. old female,  10 years post liver transplant. multiple transfusions after car accident 1978.

Last biopsy 10-03, mildly evelated LFT'S, pathology report indicated stage 2-3 grade 4. HCV RNA high at >7500 IU/ml

In your opinion should I seek treatment? Pegasys/copegus? I have no rejection since first week. Prograf level stays around 5. Taking 2 mg. twice daily.

I do have bone loss (peri.) on fosamax once weekly. Depression well controlled on Wellbutrin.  

Transplant clinic advised perhaps in a year I would need tx. Why wait?

I have great support of family. Met others who are post-transplant on bulletin boards that are undetectable of virus, after treatment.

Thank you,
Sharon (Central Florida)

[Kevin Pho, MD]

There are no controlled trials in the treatment of hepatitis C after liver transplant.  Recurrent HCV is generally treated only if it is associated with significant histologic liver injury. However, the therapeutic options are limited and rigorous clinical trials are difficult to conduct. In addition to changing immunosuppressive regimens, studies have examined the efficacy of interferon, ribavirin, and combination therapy.

The available data suggest that combination therapy with interferon and ribavirin may be useful in transplant recipients with recurrent HCV. However, there is no consensus on the optimal strategies for administering therapy. Because of the side-effect profile of these drugs many patients are not eligible for treatment or withdraw during therapy.

Other options, including retransplantation, have also been studied, but there does not seem to be a clear benefit over medications.  

Again, there is no consensus in cases such as these.  You may want to seek the opinion of several hepatologists to evaluate the best option in your case.

Followup with your personal physician is essential.

This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.

Thanks,
Kevin, M.D.

Bibliography:
Chopra et al.  Liver transplantation for hepatitis C virus infection.  UptoDate, 2004.