Pegylated-Interferon and Ribavirin for Chronic Hepatitis C Virus Infection in Decompensated Cirrhotics Awaiting Liver Transplantation

Sustained virologic response (SVR) to the antiviral therapy for chronic hepatitis C virus infection before liver transplantation (LT) can prevent graft infection. Pegylated (PEG)- interferon (IFN) may ameliorate the SVR, improving the risk-to-benefit ratio of antiviral therapy in cirrhotics awaiting LT. From January 2001 to March 2009, 21 HCV- infected cirrhotics eligible for LT were treated with PEG-IFN alpha-2b (1.5 µg/kg weight/week) and ribavirin (800-1200 mg/day). Mean age was 53.7±7.9 years. There were 11 men. Eleven had genotype 1b. Child-Pugh score was 9.5±1.2, Model for End-Stage Liver Disease score 16.6±1.8. Besides virologic failure, full dosage and planned length of therapy were tolerated in 5 patients (23.8%). Adverse events occurred in all patients, life-threatening in 9 (42.9%). No patient died during treatment. Adverse events caused treatment withdrawal in 11 patients (52.4%), ribavirin and/or PEG-IFN reduction in 7 (33.3%). On an intention-to-treat basis, SVR was obtained in 4 patients (19.0%). None of the genotype 1 or 3 patients obtained SVR; 50.0% of genotype 2 patients obtained SVR. All patients with SVR experienced rapid virological response (RVR). Six patients (three nonresponders, two relapsers, one sustained responder) were transplanted; six died; four are awaiting LT; two are under evaluation for listening; three refused LT. The risk-to-benefit ratio is against treatment with PEG-IFN and ribavirin of severely decompensated genotype 1 cirrhotics. In contrast, antiviral therapy is probably beneficial in genotype 2 subjects, due to an expected SVR rate of 50%. However, one must carefully consider the high risk for severe adverse events.