Post transplant treatment for HEP C

What treatment exists for post liver transplant and active Hepatits C?

[mikesimon]

At this time the only available treatment for transplant recipients is Interferon and Ribavirin. To my knowledge no transplant recipients have been allowed to participate in any of the new trials - Telaprevir Boceprevir.
Mike

[neptune235]

I think I'm right when I note that transplant recipients often experience an acceleration in the progression of fibrosis in the new liver.

Interferon, as an immune modulator, may intefere with anti-rejection drugs that are  normal for transplant patients.

Mike, are you aware of a "waiting period" after transplant before beginning anti-viral treatment?

[mikesimon]

Most centers wait until they see histological damage. I think I recall reading that the average time that HCV treatment is started is 48 weeks post transplant. I'm not sure about the 48 weeks but I think that's right.

You're right about accelerated fibrosis progression. I have read that different numbers but the most favorable is that 20% of HCV transplant recipients have cirrhosis within 5 years. That rate is far faster than is seen in a native liver. For some patients HCV can recur very aggressively - I was one of those patients and I started treatment within 2 months of my surgery.

I know that when I started treatment in 2000 there was a lot of concern about rejection issues with treatment. I think the concerns have lessened a bit over the years but many physicians are still extremely cautious about starting a transplant on treatment. My opinion is that today there are many tests that are pretty accurate in predicting which patients are likely to progress rapidly. These patients should treat sooner rather that waiting until there is biopsy proven fibrosis. It's difficult to start too soon however because many patients are still taking fairly large doses of anti-rejection meds. I think you have to reduce those drugs to a decent level before treating.

I think I have explained the waiting period as I understand it. Waiting 1) until there is histological evidence of damage  and 2) until the anti-rejection doses have been reduced to a lower level.
I think ideally one would like to have prednisone out of the mix and, whereas some centers don't use prednisone, the ones that do maintain prednisone for up to 6 months and some centers longer.

Mike

[tashka]

In general, it is true that the virus is more aggressive in transplanted liver, and progression to cirrhosis is much faster. But there are exceptions. I am doing a research project in a transplant center right now, and found some interesting cases. One man with hepatitis C developed cirrhosis and was transplanted 18 years ago. He never got treatment after transplant. He has yearly biopsy and is still at stage 0. Somehow, the virus didn't like this particular liver. They do wait for histological and laboratory evidence of disease progression before they try treatment. Often patients progress one stage in a year-very fast. Unfortunately, in majority of cases, treatment doesn't work and patients have to be retransplanted.