title: Boceprevir in liver transplant recipients.
abstract: BACKGROUND
  There has been increasing interest in using protease inhibitors with pegylated interferon and ribavirin to treat recurrent hepatitis C (HCV) disease in liver transplant recipients.
  
  
  METHODS
  We retrospectively evaluated the safety and efficacy in liver transplant recipients treated for recurrent hepatitis C genotype 1 with the combination of peginterferon, ribavirin and boceprevir.
  
  
  RESULTS
  Twenty liver transplant recipients were treated for recurrent hepatitis C. Baseline alanine aminotransferase, total bilirubin and HCV RNA values (± SD) were 67.5 (±50.9) mg/dl, 1.78 (±1.99) U/L, and 16 955 510 (±21 620 675) IU/ml. Anaemia was a common adverse event requiring epoetin in 16 of 20 recipients and ribavirin dose reductions in 17 of 20 recipients. One-third of recipients required a blood transfusion. Filgrastim was used in 11 of 20 patients (55%) and eltrombopag in two of 20 recipients (10%) over the course of treatment. Serum creatinine level increased significantly from a baseline value of 1.33 mg/dl to 1.59 mg/dl at week 20 of boceprevir (P < 0.005). The overall sustained viral response (SVR) was 50%. Of the 14 patients who had a viral load less than 1000 IU/ml at week 4 of boceprevir, the SVR was 71%. The SVR was 83% of the 11 patients who had undetectable viral levels at week 4 of boceprevir.
  
  
  CONCLUSIONS
  Antiviral therapy utilizing boceprevir in liver transplant recipients requires close monitoring. Anaemia and neutropenia were common requiring growth factors in most recipients. On-treatment viral responses appear promising but long-term data are needed.
authors.affiliation: Departments of Medicine, The University of California, Los Angeles, CA, USA; Departments of Surgery, The University of California, Los Angeles, CA, USA.
authors.forename: Sammy
authors.initials: S
authors.lastname: Saab
authors.forename: Vignan
authors.initials: V
authors.lastname: Manne
authors.forename: Sherona
authors.initials: S
authors.lastname: Bau
authors.forename: Justin A
authors.initials: JA
authors.lastname: Reynolds
authors.forename: Ruby
authors.initials: R
authors.lastname: Allen
authors.forename: Leonard
authors.initials: L
authors.lastname: Goldstein
authors.forename: Francisco
authors.initials: F
authors.lastname: Durazo
authors.forename: Mohammed
authors.initials: M
authors.lastname: El-Kabany
authors.forename: Steven
authors.initials: S
authors.lastname: Han
authors.forename: Ronald W
authors.initials: RW
authors.lastname: Busuttil
mesh_terms: D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D003404:Creatinine / Q000097:blood; D016903:Drug Monitoring / Q000379:methods; D005260:Female; D006526:Hepatitis C / Q000188:drug therapy*; D006801:Humans; D016898:Interferon-alpha / Q000627:therapeutic use; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D011092:Polyethylene Glycols / Q000627:therapeutic use; D011392:Proline / Q000031:analogs & derivatives* / Q000627:therapeutic use; D011480:Protease Inhibitors / Q000627:therapeutic use*; D012367:RNA, Viral / Q000097:blood; D011994:Recombinant Proteins / Q000627:therapeutic use; D012008:Recurrence; D012189:Retrospective Studies; D012254:Ribavirin / Q000627:therapeutic use; D066027:Transplant Recipients / Q000706:statistics & numerical data*
chemical_list: D016898:Interferon-alpha; D011480:Protease Inhibitors; D012367:RNA, Viral; D011994:Recombinant Proteins; D011092:Polyethylene Glycols; D012254:Ribavirin; C512204:N-(3-amino-1-(cyclobutylmethyl)-2,3-dioxopropyl)-3-(2-((((1,1-dimethylethyl)amino)carbonyl)amino)-3,3-dimethyl-1-oxobutyl)-6,6-dimethyl-3-azabicyclo(3.1.0)hexan-2-carboxamide; D011392:Proline; D003404:Creatinine; C100416:peginterferon alfa-2a
keywords: hepatitis C; liver transplant; protease inhibitors