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

Research output: Contribution to journalArticlepeer-review

51 Scopus citations


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.

Original languageEnglish (US)
Pages (from-to)196-203
Number of pages8
JournalDigestive Diseases and Sciences
Issue number1
StatePublished - Jan 2010
Externally publishedYes


  • Hepatitis C
  • Immunosuppression
  • Liver transplant

ASJC Scopus subject areas

  • Gastroenterology
  • Physiology


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