Relapse response to interferon and ribavirin in liver transplant recipient with hepatitis C recurrence

After a liver transplantation, hepatitis C virus (HCV) recurs in 90% of cases. The evolution varies according to a number of factors inherent in the host or the graft. The only therapy currently able to modify its evolution is combined interferon/ribavirin, but 22% of cases show a nonsustained response and a mere 8% achieve a sustained response. We report the case of a patient who at age 38 years underwent orthotopic liver transplantation (OLT) for HCV-related cirrhosis that developed over 7 years following blood transfusion. Following HCV recurrence at 5 years, the patient underwent 4 cycles of antiviral therapy over a 4-year period, using various protocols. First, Ribavirin alone evoked no response and the other 3 a nonsustained response. Liver biopsy after the 4th cycle showed no change in inflammation or fibrosis with respect to the biopsy performed before the first cycle. Today, at 14 years after OLT, there is still no evidence of development of cirrhosis despite immunosuppressive therapy. We suggest a benefit of repeating cycles of antiviral therapy in patients who have undergone OLT with HCV reinfection, even if they continue to show a nonsustained response but are able to tolerate the therapy.