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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

Abstract

Background

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.

Methods

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.

Results

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.

Conclusions

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.

Keywords

Immunosuppression Liver transplant Hepatitis C 

Abbreviations

CsA

Cyclosporine

EVR

Early virologic response

ETR

End-of-treatment response

HCV

Hepatitis C virus

LT

Liver transplantation

NR

Non-responder

PEG

Pegylated interferon

RT-PCR

Reverse transcription polymerase chain reaction

SVR

Sustained virological response

TAC

Tacrolimus

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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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