Background: Recurrent hepatitis C (HCV) after liver transplantation (LT) is universal and may lead to poor outcomes. Treatment with peginterferon and ribavirin (PR) after LT is less effective and associated with more side effects, including renal allograft rejection in recipients of liver and kidney transplantation (LKT). Addition of Telaprevir (TVR) to PR resulted in higher sustained virological response rates in non-LT patients with HCV genotype 1. To date, there has been no report describing the use of TVR+PR in LKT recipients. Methods: We report our experience using TVR+PR to treat recurrent HCV genotype 1 in LKT recipients, who developed significant HCV recurrence (METAVIR stage≥2). Our treatment protocol consisted of TVR+PR for 12 weeks followed by PR for 36 weeks. Maintenance immunosuppression was cyclosporine (CyA) and prednisone. During TVR treatment, CyA dose was reduced to 67-80% of q12hr dose, given once daily. Pre-TVR dosing twice daily was resumed after TVR discontinuation. Results: To date, 3 LKT recipients have been started on TVR+PR.
|Patient #||Age Race Sex||Recipient IL28B||HCV Genotype/Baseline HCV RNA (log10)||METAVIR Stage||Prior PR Treatment||Years from LT/KT||Baseline Serum Creatinine/Measured GFR|
|1||59 AA F||TT||1a/7.35||3||Partial Response||7.5/7.5||0.8/95|
|2||66 Indian M||CT||1a/5.13||2||Partial Response||3.4/3.4||0.8/71|
|3||57 AA F||TT||1a/7.70||3||Null Response||4.1/6.1||1.5/50|
No patient had an HCV RNA <1000 IU/mL at week 4. One patient discontinued TVR+PR at week 7 due to an increasing HCV RNA level (viral rebound). Of the remaining 2 patients, HCV RNA declined gradually and became negative at weeks 11 and 14, which continued through the latest follow-ups at weeks 12 and 43, respectively. Mild worsening of renal function was observed with the maximal increase of serum creatinine from baseline of 0.3-0.4 mg/dL. No biopsy proven rejection of the liver or kidney allograft was observed. All 3 patients developed anemia, requiring erythropoietin starting at weeks 2-5. No infectious complication was observed. Conclusions: Compared to recipients of LT only, on-treatment viral decay in LKT recipients appeared slower. Two of 3 patients (67%) achieved on-treatment virological response. Adverse events included mild worsening of renal function and anemia. No episodes of liver or kidney rejection were observed.
To cite this abstract in AMA style:Pungpapong S, Satyanarayana R, Rosser B, Yataco M, Mai M, Wadei H, Gonwa T, Keaveny A. First Report of Experience Using Telaprevir with Peginterferon and Ribavirin To Treat Recurrent Hepatitis C Genotype 1 in Recipients of Liver and Kidney Transplantation [abstract]. Am J Transplant. 2013; 13 (suppl 5). https://atcmeetingabstracts.com/abstract/first-report-of-experience-using-telaprevir-with-peginterferon-and-ribavirin-to-treat-recurrent-hepatitis-c-genotype-1-in-recipients-of-liver-and-kidney-transplantation/. Accessed October 26, 2020.
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