Discordance between ALT values and fibrosis in liver transplant recipients treated with ribavirin for recurrent hepatitis C

Sammy Saab, Rena Hu, Ayman B. Ibrahim, Leonard I. Goldstein, Gregg Kunder, Francisco Durazo, Steven Han, Hasan Yersiz, Rafik M. Ghobrial, Douglas G. Farmer, Ronald W. Busuttil, Charles Lassman

Research output: Contribution to journalArticle

16 Scopus citations

Abstract

Hepatitis C virus (HCV) recurrence is a serious problem after orthotopic liver transplantation (OLT). The role of ribavirin as a single agent to treat recurrent HCV is controversial. Our aim was to evaluate the correlation between alanine aminotransferase (ALT) levels and histological findings in OLT recipients treated with ribavirin monotherapy for recurrent HCV. The mean [± standard error (SE)] age of 11 patients was 50.1 (SE ± 8.6) years. The estimated mean dose and duration of ribavirin treatment (± SE) was 661.5 (± 52.5) mg and 20.4 (± 1.7) months, respectively. Five patients required either dose reduction or erythropoietin. We found a significant decrease of mean (± SE) ALT value from 246 ± 44.8 U/L to 109.4 ± 49.1 U/L (p = 0.002) in patients treated with ribavirin. However, there was also significant worsening of interface activity (p = 0.03) and fibrosis (p = 0.02). No significant association was found between ALT values and (i) stage of hepatic fibrosis, (ii) interface activity, (iii) lobular activity and (iv) HCV RNA values. Our results suggest that HCV disease can progress despite a significant decrease in ALT values. ALT values are inadequate markers of the ribavirin monotherapy and can lead to erroneous conclusions of efficacy.

Original languageEnglish (US)
Pages (from-to)328-333
Number of pages6
JournalAmerican Journal of Transplantation
Volume3
Issue number3
DOIs
StatePublished - Mar 2003

Keywords

  • Hepatitis C
  • Liver transplantation

ASJC Scopus subject areas

  • Immunology

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