Post-Transplant Treatment

[Sky_King]

Dr. Schiano,

My husband's transplant center is proposing 1 year of Pegasys (180mcg) and Ribavirin (1000mg) followed by a year of Pegasys alone to treat his recurrent HCV.  Have you heard of that kind of treatment before?  Why would the 2nd year be Pegasys alone?  What do you do at your center in this situation?

Do you feel that it is important to get a viral load test at 4 weeks?  How often should the viral load test be done?  What is the procedure at your center?

Thank you for your advice.

[Thomas D Schiano, MD]

Ok.  Definitely i would do the first year.  if the perfson becomes viral load (-) we would stop treatment after 1 year.  If the virus returns we would then retreat and keep on maintenance interferon therapy to prevent fibrosis from worsening.  Stage 2 fibrosis definitely wants strong consideration of treatment.  We typically check viral loads every 1-2 months.

[Sky_King]

I should have said that he has had 2 biopsies since the transplant.  The hepatitis has returned with grade 2 inflammation and stage 1-2 fibrosis so this is not preemptive therapy.   His enzymes are quite high so they have decided to treat right away.  I stilll have these questions.

My husband's transplant center is proposing 1 year of Pegasys (180mcg) and Ribavirin (1000mg) followed by a year of Pegasys alone to treat his recurrent HCV.  Have you heard of that kind of treatment before?  Why would the 2nd year be Pegasys alone?  What do you do at your center in this situation?

Do you feel that it is important to get a viral  load test at 4 weeks?  How often should the viral load test be done?  What is the procedure at your center?

Thank you for your advice.

[Thomas D Schiano, MD]

we do not use preemptive therapy after transplantation.  this is really only being done as part of a study protocol.  There have been small studies looking at this with very poor success rates and treatment is very difficult to tolerate, so early after transplantation.  you can refer to a study by chalasani et al from Hepatology et al a couple of years ago.  we do not treat until the HCV returns to the liver which is manifested by abnormal liver tests and a biopsy showing the HCV.