Background: Experience with treatment for HCV recurrence in liver transplant recipients (LTRs) using pegylated interferon, ribavirin (PR) and protease inhibitors (PIs) is limited.

Methods: Adult genotype 1 LTRs with biopsy-proven HCV recurrence were converted to a cyclosporine (CsA) based immunosuppression regimen (goal trough∼ 100ng/ml) prior to TTx. After successful conversion, protocol proceeded with a 2 week lead-in phase of low accelerating dose regimen of PR followed by BOC 800mg thrice daily. Interferon responsiveness (IFNr) was defined as >1 log drop in HCV viral load after 2 weeks of lead-in with PR, and complete early virological response (cEVR) was defined as viral clearance (VC) at 12 weeks of TTx.

Results: Eleven patients received TTx for a mean of 18.9±7.6 weeks. Mean age and time after transplant were 56.7±6.6 and 2.8±1.6 years, respectively. Nine of the 11 patients were male, and 8 were Caucasian. The mean steady state pre-BOC CsA dose was decreased by 29.7±12.6% during TTx. At 12 weeks, 9 of 11 (81.8%) achieved cEVR. Mean time to VC was 7.5±2.7 weeks (n=9). At 24 weeks, data were available on 7 patients, and 6 (85.7%) had VC. IFNr was achieved in 8/10 patients who received at least 2 weeks of lead-in, and 100% of those achieved cEVR. Those without IFNr (n=2) required early discontinuation due to futility. Anemia (hemoglobin <10 g/dl) developed in 91% of the cohort. Patients were transfused PRBC (mean 5.2 units) during TTx and all required erythropoietin. No episodes of rejection occurred.

Conclusions: 1) BOC based TTx demonstrated excellent early virological response in LTRs with HCV recurrence, even in recipients with advancing graft fibrosis. 2) IFNr during the lead-in phase may be a predictor of treatment efficacy and may help to determine which patients should receive TTx.

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