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The aim of the study was to evaluate the efficacy of triple antiviral therapy with interferon, ribavirin, and amantadine in comparison with interferon and ribavirin combination treatment in patients with interferon-nonresponsive chronic hepatitis C. We performed an open-label, prospective randomized controlled trial at a secondary referral center. We used a 2:1 ratio, patients received interferon, ribavirin, and amantadine, or interferon and ribavirin for 12 months, and were followed up for an additional 6 months. Ninety-four consecutive adult interferon nonresponders with chronic hepatitis C were screened. Sixty consecutive elected patients entered the study. No patients withdrew because of adverse effects. Forty patients received interferon alfa (5 megaunits on alternate days), ribavirin (800-1,000 mg daily), and amantadine ( The combination of interferon alfa and ribavirin is effective as both initial treatment and re-treatment of relapse in patients with chronic hepatitis C. 1-3 Re-treatment for interferon nonresponders is not currently recommended because, unfortunately, both interferon alfa and the combination of interferon plus ribavirin have obtained limited results in interferon nonresponders. 4,5

Chronic hepatitis C represents a major clinical problem after liver transplantation, but factors influencing the recurrent disease have not been well characterized. We analyzed the clinical records of all the patients transplanted for hepatitis C virus (HW-related liver disease in our Center between 1991 and 1997. Eighty consecutive HCV-positive (+) patients (60 men, ages 28 to 64) survived more than 1 month after transplantation and were followed for a median of 45 months. Diagnosis of recurrent chronic hepatitis C was made in 38 patients (47.5%), of whom 22 had moderate/severe chronic hepatitis. Decompensated cirrhosis occurred in six patients (7.5%).N o difference in patient survival was found between patients with and without hepatitis C recurrence. N o association was found between recurrent hepatitis C and presumed risk factors. The method of tapering off corticosteroids was significantly associated with both hepatitis C recurrence and the severity of hepatitis. In patients receiving a higher daily prednisone dose, 12 months after transplantation, the proportion of recurrent hepatitis C was The aim of our study was to evaluate the clinical records of all patients who underwent transplantation in our single center during the last decade to outline the features of recurrent hepatitis C and, possibly, to identi!+ the risk factors eventually associated with the more severe forms of this disease. 35 Patients and Methods Patient PopulationBetween January, 1991 and December, 1997, 25 1 adult patients underwent OLT at the Department of Surgery and Transplantation, University of Bologna, ofwhom 97 received liver graft for end-stage liver disease secondary to HCV infection. Of these patients, 12 with a concomitant hepatitis B virus (HBV) infection, one with de novo HBV infection after OLT, and four who died within 30 days after surgery were excluded from the analysis. Therefore, our study population included 80 consecutive patients (60 men and 20 women, ages ranging from 28 to 64 years), who underwent transplatation for HCV-related liver disease, who survived more than 1 month after OLT, with well-established HCV infection (anti-HCV and HCV-RNA positivity by polymerase chain reaction) before and after after liver transplant, Clinical and laboratory data were available for the complete series of patients at the time of transplantation and subsequently.