1Departments of Medicine, the University of California at Los Angeles; Departments of Surgery, the University of California at Los Angeles.
There has been increasing interest in using protease inhibitors with pegylated interferon and ribavirin to treat recurrent hepatitis C (HCV) disease in liver transplant recipients.
We retrospectively evaluated the safety and efficacy in liver transplant recipients treated for recurrent hepatitis C genotype 1 with the combination of peginterferon, ribavirin, and boceprevir.
Twenty liver transplant recipients were treated for recurrent hepatitis C. Baseline alanine aminotransferase, total bilirubin, and HCV RNA values (± SD) were 67.5 (±50.9) mg/dl, 1.78 (±1.99) U/L, and 16,955,510 (±21,620,675) IU/mL. Anemia was a common adverse event requiring epoetin in 16 of 20 recipients and ribavirin dose reductions in 17 of 20 recipients. One third of recipients required a blood transfusion. Filgrastim was used in 11 of 20 patients (55%) and eltrombopag in 2 of 20 recipients (10%) over the course of treatment. Serum creatinine level increased significantly from a baseline value of 1.33 mg/dL to 1.59 mg/dL at week 20 of boceprevir (p<0.005). The overall sustained viral response (SVR) was 50%. Of the 14 patients who had a viral load less than 1000 IU/mL at week 4 of boceprevir, the SVR was 71%. The SVR was 83% of the 11 patients who had undetectable viral levels at week 4 of boceprevir.
Antiviral therapy utilizing boceprevir in liver transplant recipients requires close monitoring. Anemia and neutropenia were common requiring growth factors in most recipients. On-treatment viral responses appear promising but long term data is needed.