Achievement of Sustained Viral Response after Switching Treatment from Pegylated Interferon a-2b to a-2a and Ribavirin in Patients with Recurrence of Hepatitis C Virus Genotype 1 Infection after Liver Transplantation: A Case Report

Kawaoka, Tomokazu; Hiraga, Nobuhiko; Takahashi, Shoichi; Takaki, Shintaro; Tsuge, Masataka; Nagaoki, Yuko; Hashimoto, Yoshimasa; Katamura, Yoshio; Miki, Daiki; Hiramatsu, Akira; Waki, Koji; Imamura, Michio; Kawakami, Yoshiiku; Aikata, Hiroshi; Ochi, Hidenori; Tashiro, Hirotaka; Ohdan, Hideki; Chayama, Kazuaki

doi:10.1159/000328661

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“…THE SVR RATE has improved since the introduction of PEG IFN/RBV for patients who undergo LT for HCV‐related end‐stage liver disease. The current estimated SVR rate for LT patients with history of HCV genotype 1 infection is 30–50% . These results are much better than those reported in the 1990s and early 2000s, however, more than half of recipients still suffer from recurrent chronic hepatitis C.…”

Section: Discussionmentioning

confidence: 79%

Two patients treated with pegylated interferon/ribavirin/telaprevir triple therapy for recurrent hepatitis C after living donor liver transplantation

Kawaoka

Takahashi²,

Tatsukawa

et al. 2014

Hepatology Research

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It is difficult to use protease inhibitors in patients with recurrent hepatitis C virus (HCV) infection after liver transplantation (LT) due to interaction with immunosuppressive drugs. We report our experience with two patients treated with telaprevir (TVR) combined with pegylated interferon/ribavirin (PEG IFN/RBV) for recurrent HCV genotype 1 infection after LT. The first was a 63-year-old man with HCV-related liver cirrhosis, who failed to respond to IFN-β plus RBV after LT. Treatment was switched to PEG IFN-α-2b plus RBV and TVR was started. The donor had TT genotype of interleukin (IL)-28 single nucleotide polymorphisms (SNP) (rs8099917). The recipient had TT genotype of IL-28 SNP (rs8099917). Completion of 12-week triple therapy was followed by PEG IFN-α-2b plus RBV for 36 weeks. Finally, he had sustained viral response. The second was a 70-year-old woman with HCV-related liver cirrhosis and hepatocellular carcinoma. She failed to respond to PEG IFN-α-2b plus RBV after LT, and was subsequently switched to PEG IFN-α-2b/RBV/TVR. Genotype analysis showed TG genotype of IL-28 SNP for the donor, and TT genotype of IL-28 SNP for the recipient. Serum HCV RNA titer decreased below the detection limit at 5 weeks. However, triple therapy was withdrawn at 11 weeks due to general fatigue, which resulted in HCV RNA rebound 4 weeks later. Both patients were treated with cyclosporin, starting with a small dose to avoid interactions with TVR. TVR is a potentially suitable agent for LT recipients who do not respond to PEG IFN-α-2b plus RBV after LT.

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Section: Discussionmentioning

confidence: 79%