Treatment of Hepatitis C-Virus–Reinfection After Liver Transplant with Silibinin in Nonresponders to Pegylated Interferon-based Therapy

Abstract

Objectives: Hepatitis C-virus–persistence after orthotopic liver transplant leads to reduced patient and graft survival compared to other indications. Current interferon-based antiviral therapy of hepatitis C-virus–infection posttransplant provides a sustained response rate of 30% to 40%. This study, performed in an hepatitis C-virus-reinfected liver transplant population, examines the antiviral effect of intravenously administered silibinin, recently reported to exhibit strong antiviral properties in the natural setting of hepatitis C-virus–related liver disease.

Patients and Methods: Four patients after orthotopic liver transplant with hepatitis C-virus–recurrence, previously having not responded to peg-interferon-ribavirin therapy, were treated with intravenous silibinin and additionally, after the 10th day, with standard interferon-based therapy. Aminotransferases and hepatitis C-virus–RNA were measured during treatment.

Results: All patients demonstrated normalization of liver enzymes and significant decline of hepatitis Cvirus–RNA measured at day 10 (mean 2.8 logarithmic levels: 1.7, 2.3, 2.9, and 4.3) during silibinin monotherapy. One patient cleared hepatitis C-virus–RNA under silibinin monotherapy and another patient eliminated hepatitis C virus under subsequent interferon-based therapy. No adverse effects were observed during silibinin application.

Conclusions: Intravenous silibinin is an effective therapeutic approach for treating hepatitis C-virus–reinfection after liver transplant and should be evaluated further.