Background: Management of recurrent hepatitis C infection remains a major challenge after liver transplantation. Protease-inhibitor based regimens improve virological response in non-transplanted HCV genotype 1 patients. We report here, the Belgian experience of Boceprevir-based tritherapy after liver transplantation. Methods: Safety and efficacy of Boceprevir treatment in combination with PegIFN+ribavarin were investigated in 7 HCV genotype 1 liver transplanted patients (3/7 men with a mean of age 53+/-10.4 years), with recurrent chronic HCV. Two patients had cholestatic hepatitis, 5 had chronic hepatitis with F1 (n=1), F2 (n=1), F3 (n=1) and F4 (n=2) fibrosis stage according to the METAVIR score. Results: The median time between LT and HCV treatment initiation was 249 days [47-2411].Lead-in period was not the same in all patients with a median time of 7 weeks [4-26 weeks]. The median follow-up period was 33 [15.86-54.43] weeks. All patients had achieved a steady state of immunosuppressive drugs before the initiation of Boceprevir: 3 patients had tacrolimus and mycophenolate mofetil, 1 had cyclosporine, 1 had cyclosporine, mycophenolate mofetil and corticoid and 1 had everolimus and mycophenolate mofetil. Because of drugs interaction, immunosuppressant treatment was reduced in all but one patient. Cyclosporine and Tacrolimus doses were reduced by 1.9 and 3.77, respectively. Anemia occurred in all patients requiring ribavirin doses reduction in all patients, blood transfusion in 6 patients, erythropoietin administration in 4 patients and boceprevir cessation in one patient after 8 weeks of tritherapy. Median HCV viral load at the beginning of HCV treatment and at the time of boceprevir initiation were respectively 7.54 10⁶ [1.07 10⁶ – 7 10⁷] and 5.85 10⁵ [2.59 10⁴ -5.5 10⁷ ]IU/ml. After 8 weeks of tritherapy, 5 patients had HCV viral load below 30 IU/ml and remained negative till end of follow-up, 1 patient had 402 IU/ml and relapsed and 1 had stopped treatment because of severe anemia and thrombocytopenia at W4. Conclusions: these results confirm the feasibility of boceprevir based tritherapy in liver transplanted patients. Efficacy results are promising but a close monitoring of immunosuppressive drug levels and of hematological side effects is required.

DegrÉ, D.: Grant/Research Support, MSD. Colle, I.: Grant/Research Support, MSD, Speaker’s Bureau, MSD. Van Vlierberghe, H.: Grant/Research Support, MSD, Speaker’s Bureau, MSD. Moreno, C.: Grant/Research Support, MSD, Speaker’s Bureau, MSD.

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