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126 What's the prognosis & treatment of Hep C in liver transplant patients?




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This article is from the Organ Transplant FAQ, by mike_holloway@hotmail.com (Michael Holloway) with numerous contributions by others.

126 What's the prognosis & treatment of Hep C in liver transplant patients?

Question:
What is the prognosis for and treatment of liver transplant recipients with
Hepatitis C? is Interferon B renal toxic? What have been the results of
using Ribivirin for treatment of Hep C generally?

Answer:
In non-transplant patients with hepatitis C, interferon therapy has been
shown to have a fairly good response rate. The biggest two problems are
that the therapy must be taken for a long time (usually at least 26 weeks)
and the patient has to give him/herself injections several times per week.
Unfortunately, only about 25% of patients have a sustained response after
the therapy is stopped. After liver transplantation, interferon's track
record has been even less stellar. There have been no randomized trials
(this is a way of critically evaluating new treatments to see if they
really are better than existing standard therapy). Likewise, ribivarin has
been used only anecdotally after liver transplant. The good news is that
many patients with hepatitis C who receive a liver transplant do extremely
well for many years. By blood testing, almost all show evidence that the
virus is still present and it usually will eventually set up shop in the
transplanted liver, although severe hepatitis with symptoms is the
exception rather than the rule. Long term, the hepatitis certainly may
damage the transplanted liver, but this is unpredictable both in terms of
timing and severity.

Bob Merion, MD (transplant surgeon), University of Michigan
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