Effect of maintenance therapy with low‐dose peginterferon for recurrent hepatitis C after living donor liver transplantation

Summary.  Approximately 30% of patients who have recurrent hepatitis C after liver transplantation achieve sustained virological response (SVR) by taking a combination therapy of pegylated interferon and ribavirin. For the remaining non‐SVR patients, an effective management treatment has not yet been established. In this study, efficacy of long‐term peginterferon maintenance therapy for non‐SVR patients was evaluated. Forty patients who had previously received the combination therapy for hepatitis C after living donor liver transplantation were classified into one of the following three groups: the SVR group (n = 11); the non‐SVR‐IFN group (n = 17), which received low‐dose peginterferon maintenance therapy for non‐SVR patients; and the non‐SVR‐Withdrawal group (n = 12), which discontinued the interferon treatment. We then compared histological changes among these three groups after 2 or more years follow‐up. Activity grade of liver histology improved or remained stable in patients in the SVR and non‐SVR‐IFN groups, but deteriorated in half of the patients in the non‐SVR‐Withdrawal group. Fibrosis improved or remained stable in 10 of 11 SVR patients and in 13 of 17 non‐SVR‐IFN patients, but deteriorated in all non‐SVR‐Withdrawal patients. Mean changes in fibrosis stage between pretreatment and final liver biopsy were −0.18, +0.06 and +2.2 in the SVR, non‐SVR‐IFN and non‐SVR‐Withdrawal groups, respectively. Fibrosis stage deteriorated to F3 or F4 significantly more rapidly in the non‐SVR‐Withdrawal group than in the other two groups. In conclusion, continuing long‐term maintenance therapy with peginterferon prevented histological progression of hepatitis C in patients who had undergone living donor liver transplantation.