Two-Year Follow-Up Analysis of Telaprevir-Based Antiviral Triple Therapy for HCV Recurrence in Genotype 1 Infected Liver Graft Recipients as a First Step towards Modern HCV Therapy.

Fritz Klein,Ruth Neuhaus,Jörg Hofmann,Sandra Bayraktar,Marcus Bahra,Johann Pratschke,Dennis Eurich

doi:10.1155/2016/8325467

Fritz Klein, Ruth Neuhaus + Show 5 more

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https://doi.org/10.1155/2016/8325467

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Abstract

Objective. The introduction of protease inhibitors telaprevir and boceprevir in 2011 had extended the antiviral treatment options especially in genotype 1 infected hepatitis C relapsers and nonresponders to interferon/ribavirin therapy. The aim of this study was to analyze the long-term treatment efficiency of telaprevir-based triple therapy for patients with hepatitis C reinfection after orthotopic liver transplantation. Patients and Methods. We included 12 patients with histologically confirmed graft fibrosis due to hepatitis C reinfection. The treatment duration was scheduled as 12 weeks of telaprevir-based antiviral triple therapy followed by 36 weeks of dual therapy with pegylated interferon/ribavirin. The patients were followed up for two years after the end of triple therapy. Results. Of the 12 patients, 6 (50%) completed the full 48 weeks of antiviral treatment. An end of treatment response and a sustained virological response 52 weeks after the end of the antiviral treatment course were achieved in 8/12 (67%) and 7/12 (58%) patients, respectively. Conclusion. Telaprevir-based triple therapy was shown to be a long-term effective but complex treatment option for individual patients with hepatitis C graft. With the recent improvements in hepatitis C therapy options telaprevir may not be recommended as a standard therapy for this indication anymore.

Highlights

Hepatitis C Virus (HCV) recurrence after orthotopic liver transplantation (OLT) is the major cause of graft failure and death in HCV recipients [1]
Graft reinfection with accelerated fibrosis deposition occurs in all patients with detectable HCV ribonucleic acid (HCV RNA) at the time of transplantation, and 30% of these patients will develop graft cirrhosis within 5 years after OLT, with a mortality risk directly related to HCV recurrence of 15% [2, 3]
All patients included in this study had confirmed HCV recurrence with detectable HCV RNA in the PCR analysis and biopsy-proven graft fibrosis according to the Desmet and Scheuer classification (0, absent; 1, mild without septa; 2, moderate with few septa; 3, numerous septa without cirrhosis; and 4, cirrhosis) [21]

Summary

Introduction

Hepatitis C Virus (HCV) recurrence after orthotopic liver transplantation (OLT) is the major cause of graft failure and death in HCV recipients [1]. In addition to high HCV RNA levels in the early post-OLT period, factors such as HCV genotypes 1 and 4 as well as an older donor age, graft steatosis, the degree of human leukocyte antigen (HLA) matching, and the IL28B genotype of the donor and recipient have been identified as negative predictive factors for HCV recurrence [4, 5]. Obtaining a sustained virological response (SVR) by successful antiviral therapy can distinctly improve the graft and overall patient survival [6, 7]. In addition to a poor tolerance, especially in transplanted patients, overall SVR was only achieved in one-third of HCV-positive recipients (−30% GT1, −50% GT5) [8, 9].

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