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The use of interferon for the treatment of viral hepatitis in pediatric liver transplant recipients.

Between January 1990 and July 1992, 12 children with viral hepatitis occurring after liver transplantation (LTx) were treated with interferon alpha-2b. Seven were female and 5 were male; their ages ranged between 0.7 and 14.7 years (mean = 5.4 years). The indications for LTx included biliary atresia (n = 7), chronic active hepatitis (n = 2), and fulminant hepatitis (n = 3). Therapy was initiated at a dose of 1-3 million units (5 million units/1.73 m2) given 3 times per week and continued for more than six months. Six patients experienced a full response with normalization of their serum liver enzymes and a complete resolution of histologic hepatitis on liver biopsy. Two patients had a partial response with improvement in their liver enzyme values. Four patients required retransplantation for worsening hepatitis despite interferon (IFN) therapy. Three of these four were treated prophylactically with IFN therapy after their second transplant. Two of these four have shown no clinical or histologic evidence of hepatitis in their second liver after a follow-up of 20 and 4 months. IFN failed to prevent recurrent hepatitis in the other two children. One died at retransplant and the second developed recurrence of the giant cell hepatitis and rejection. Overall, IFN was well-tolerated by 11 of the 12 children; the 12th child required a dose reduction because of seizures. Based upon this preliminary uncontrolled experience, we conclude that the use of interferon alpha-2b is safe and effective in the treatment of viral hepatitis in children after liver transplantation.