Antiviral treatment withdrawal in viremic HCV-positive liver transplant patients: Impact on viral loads, allograft function and morphology

Background: The aim of this study was to evaluate the clinical long-term consequences of antiviral treatment discontinuation in viremic hepatitis C virus (HCV)-positive liver transplant recipients. Methods: Twenty-five HCV-positive patients after liver transplantation were included in this study. After diagnosing recurrent hepatitis C, a combination therapy with interferon-α2b and ribavirin for a minimum of 12 months was initiated. Viremia levels and allograft function were monitored continuously. Allograft biopsies were performed yearly, analyzing grading of inflammation and staging of fibrosis. Results: HCV recurrence rate was 100%. Up to 114 months post-transplantation, sustained virological response rate was 64%. Treatment discontinuation in virological nonresponders led subsequently to a significant increase of viral loads and deterioration of allograft function (P < 0.05) within 1 month. In three patients, a fibrosing cholestatic syndrome developed, resulting in one patient death. Antiviral retherapy was maintained for a mean of 33 months, leading to a significant decline of aminotransferases (P < 0.05) as well as decreasing serum levels of bilirubin and HCV-RNA within 6 months. In addition, development of severe allograft fibrosis was prevented despite persistent viral loads. Conclusion: Our study suggests that antiviral treatment withdrawal carries the risk of severe disease progression in persistently viremic HCV-positive liver transplant patients.