The safety, efficacy, and effect on immunosuppression levels of telaprevir (TVR) or boceprevir (BOC) in combination with peginterferon (PEG-IFN) and ribavirin (RBV) in recipients of liver transplantation (LT) with hepatitis C virus (HCV) genotype 1 have not been defined. We report our 3 centers' preliminary experiences with administering triple antiviral treatment protocols containing PEG-IFN, RBV, and TVR or BOC. Patients with biopsy-proven HCV recurrence (METAVIR grade ≥ 3 and/or stage ≥ 2) received TVR with PEG-IFN/RBV for 12 weeks and then PEG-IFN/RBV for 36 weeks or BOC with PEG-IFN/RBV for 44 weeks after 4 weeks of lead-in PEG-IFN/RBV. Maintenance immunosuppression was changed to cyclosporine whenever possible, and the levels were followed closely. PEG-IFN/RBV dose adjustments were based on patients' tolerance. Sixty patients started triple antiviral treatment, and they were followed for up to 66 weeks (mean = 35 weeks); all were followed at least 12 weeks. Thirty of the 35 patients treated with TVR (86%) achieved undetectable HCV RNA levels after an average of 6 weeks, whereas 12 patients (48%) in the BOC-treated group achieved undetectable HCV RNA levels after a mean of 11 weeks. According to an intention-to-treat analysis, 14 of 21 TVR-treated patients (67%) and 10 of 22 patients who received BOC (45%) achieved undetectable HCV RNA levels at week 24 without viral breakthrough at the last follow-up. Cytopenias complicated both regimens; all patients required dose reductions of PEG-IFN and/or RBV or the administration of hematological growth factors. One death occurred in each group on triple antiviral treatment. In conclusion, TVR or BOC combined with PEG-IFN/RBV achieved on-treatment virological response rates of approximately 50% to 60% in patients with recurrent HCV after LT, but significant side effects were common. Copyright

Hepatitis C virus, acute graft rejection, adult, anemia, anorectal disease, antiviral therapy, article, ascites, cardiovascular disease, cellulitis, controlled study, cytopenia, decompensated liver cirrhosis, drug dose reduction, drug efficacy, drug fatality, drug safety, drug substitution, drug tolerability, drug treatment failure, drug withdrawal, dysgeusia, erythrocyte concentrate, erythrocyte transfusion, female, genotype, glomerulus filtration rate, graft recipient, hepatic encephalopathy, hepatitis C, herpes zoster, human, immunosuppressive treatment, infection, kidney failure, leukopenia, liver transplantation, major clinical study, male, periodontal abscess, pneumonia, posterior reversible encephalopathy syndrome, priority journal, rash, reinfection, sinusitis, thrombocytopenia, treatment duration, treatment response, urinary tract infection
dx.doi.org/10.1002/lt.23669, hdl.handle.net/1765/41193
Liver Transplantation
Erasmus MC: University Medical Center Rotterdam

Pungpapong, S, Aqel, B.A, Koning, L, Murphy, J.L, Henry, T.M, Ryland, K.L, … Keaveny, A.P. (2013). Multicenter experience using telaprevir or boceprevir with peginterferon and ribavirin to treat hepatitis C genotype 1 after liver transplantation. Liver Transplantation, 19(7), 690–700. doi:10.1002/lt.23669