The Use of Cyclosporine for Recurrent Hepatitis C After Liver Transplant: A Randomized Pilot Study

  • Roberto J. Firpi
  • Consuelo Soldevila-Pico
  • Giuseppe G. Morelli
  • Roniel Cabrera
  • Cynthia Levy
  • Virginia C. Clark
  • Amitabh Suman
  • Anthony Michaels
  • Chaoru Chen
  • David R. Nelson
Original Article



Cyclosporine has antiviral activity in vitro against hepatitis C (HCV). We performed a pilot study to prospectively determine the antiviral effect of cyclosporine during therapy with PEGalfa-2a and ribavirin in liver transplant recipients with recurrent HCV infection.


Patients with HCV recurrence (Ishak Fibrosis Stage ≥ 2) were enrolled for 2 years at the University of Florida. Thirty-eight patients were randomized to continued tacrolimus or switched to cyclosporine. Both groups received PEGalfa-2a and ribavirin.


Twenty patients received tacrolimus and 18 cyclosporine, with a mean age of 53. Eighty-two percent were men, 84% Caucasian, and 90% genotype 1. In patients switched from tacrolimus to cyclosporine, HCV-RNA levels decreased by a mean of 0.39 million IU/ml during the 1 month prior to initiating PEG/RBV. Sustained viral response for cyclosporine was higher than in patients on tacrolimus receiving PEG/RBV therapy.


This randomized controlled pilot study is the first in vivo study evaluating cyclosporine versus tacrolimus in liver transplant recipients undergoing antiviral therapy. Change from tacrolimus to cyclosporine led to a modest HCV RNA drop and appeared to enhance the antiviral response of PEG/RBV. A larger randomized study is necessary to see if cyclosporine offers any advantage over tacrolimus.


Immunosuppression Liver transplant Hepatitis C 





Early virologic response


End-of-treatment response


Hepatitis C virus


Liver transplantation




Pegylated interferon


Reverse transcription polymerase chain reaction


Sustained virological response




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Copyright information

© Springer Science+Business Media, LLC 2009

Authors and Affiliations

  • Roberto J. Firpi
    • 1
    • 2
  • Consuelo Soldevila-Pico
    • 1
  • Giuseppe G. Morelli
    • 1
  • Roniel Cabrera
    • 1
  • Cynthia Levy
    • 1
  • Virginia C. Clark
    • 1
  • Amitabh Suman
    • 1
  • Anthony Michaels
    • 1
  • Chaoru Chen
    • 1
  • David R. Nelson
    • 1
  1. 1.Division of Gastroenterology, Hepatology and Nutrition Section of Hepatobiliary Diseases and Liver TransplantationUniversity of FloridaGainesvilleUSA
  2. 2.Department of Medicine, Section of Hepatobiliary DiseasesUniversity of FloridaGainesvilleUSA

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