Background and Aims:Triple therapy(TT) with pegylated interferon(P), ribavirin(R) and a protease inhibitor(PI) improves sustained virologic response(SVR) rates in non-liver transplant(LT) genotype 1 HCV-infected patients. We aimed to determine extended rapid virologic response(eRVR) and adverse event(AE) rates in post-LT recipients treated with TT. Methods:6 high volume US transplant centers treated genotype 1 HCV-infected LT recipients with TT. Telaprevir was used in 89% with PR lead-in(LI) in 97%. 16 with ≥90 days of LI were excluded from efficacy but not safety analyses. Results:120 patients with a median age of 58 years, 77% male, 11% AA, and 55% with genotype 1a were analyzed. 54% had prior post-LT treatment(48% null, 24% partial, 28% relapsers), 83% stage 2-4 fibrosis & 11% fibrosing cholestatic hepatitis. Immunosuppression included cyclosporine in 61%, tacrolimus in 29%, steroids in 26% and mycophenolate in 77%. Median daily cyclosporine & tacrolimus doses prior/after PI were 200/50mg and 1.0/0.19mg, respectively. Median treatment duration was 148(IQR:66-219) days with median LI of 30(IQR:28-41) days. Despite erythopoetin use in 79%, GCSF in 43%, R & P dose reduction in 80% & 38% respectively, AEs were common: 45% of patients required blood transfusions, 20% required hospitalization, 26% experienced drug interruption or discontinuation, 33% had a creatinine increase ≥0.5 mg/dL, 4% experienced rejection & 1.7% died. 6 simultaneous liver-kidney transplant patients are receiving TT, and one renal Banff 2b rejection occurred. Viral negativity occurred at week 4 of TT in 63%(62/98) which increased to 78%(67/85) by week 12 leading to a 62% eRVR. HCV RNA remained negative at week 24 in 72%(46/64) & breakthrough occurred in 9% of patients. Conclusions:TT in highly selected post-LT recipients requires intense monitoring with common AE and a 1.7% risk of death. However, with appropriate management of drug-drug interactions, dose modifications, & AEs we achieved eRVR in 62% of LT recipients. SVR data will be presented on those who have completed therapy.

O'Leary, J.: Speaker’s Bureau, Vertex. Levitsky, J.: Speaker’s Bureau, Vertex. Everson, G.: Grant/Research Support, Vertex, Merck. Brown, R.: Other, Merck, Consultant, Vertex, Consultant.

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