Maintenance ribavirin monotherapy delays fibrosis progression in liver transplant recipients with recurrent hepatitis C at high risk of progression

作者：Lionetti Raffaella; Tisone Giuseppe; Palmieri Giampiero; Almerighi Cristiana; Anselmo Alessandra; Tariciotti Laura; Lenci Ilaria; De Luca Linda; Monaco Andrea; Angelico Mario^*

来源：Digestive and Liver Disease, 2010, 42(4): 297-303.

DOI：10.1016/j.dld.2009.08.008

• Disease recurrence
• Grading
• Graft
• Immunosuppression
• Staging

Background: Fibrosis in liver transplant recipients with recurrent HCV is fast, yet, different patterns of progression are recognized.
Aims: To investigate histological findings associated with maintenance ribavirin monotherapy in patients with recurrent HCV transplanted >= 4 years earlier.
Methods:14 recipients at high risk of progression (fibrosis progression rate >0.33 units/year and/or persistently elevated ALT) were assigned to receive ribavirin for 3 years. 11 patients at lower risk of progression (FPR <= 0.33 units/year and normal ALT) as controls. Biopsies were obtained yearly since transplant and 7 consecutive biopsies were evaluated.
Results: Improved necroinflammation (reduction >= 2 grading) was observed in 7 treated with ribavirin and 3 untreated patients, while 1 and 3 patients worsened respectively. Fibrosis improved (reduction >1 staging) in 2 ribavirin-treated patients, unchanged in 10 and worsened (increase >1 staging) in 2. Fibrosis progression decreased from 0.48 +/- 0.27 observed during the 3-year pre-treatment period to 0.04 +/- 0.31 units/year (p = 0.003) during the 3 years of ribavirin. Among untreated fibrosis remained unchanged in 1 and worsened in 10 (p<0.001), yearly fibrosis progression rate increasing from 0.15 +/- 0.17 units/year to 0.42 +/- 0.39 units/year (p = 0.10).
Conclusions: Maintenance ribavirin monotherapy delays fibrosis progression in high risk patients, offering an alternative strategy for those failing to respond to conventional treatment.

• 出版日期2010-4