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Z Gastroenterol 2014; 52(1): 27-34
DOI: 10.1055/s-0033-1356345
Originalarbeit
© Georg Thieme Verlag KG Stuttgart · New York

Treatment of Recurrent Genotype 1 Hepatitis C Post-Liver Transplantation: Single Center Experience with Telaprevir-Based Triple Therapy

Die Behandlung der Hepatitis-C-Genotyp-1-Reinfektion nach Lebertransplantation: Tübinger Erfahrungen mit der Telaprevir-Triple-Therapie
C. R. Werner
1   University Hospital Tübingen, Medical Clinic, Department of Gastroenterology, Hepatology, and Infectiology, Tübingen, Germany
,
D. P. Egetemeyr
1   University Hospital Tübingen, Medical Clinic, Department of Gastroenterology, Hepatology, and Infectiology, Tübingen, Germany
,
S. Nadalin
2   University Hospital Tübingen, Department of General, Visceral and Transplant Surgery, Tübingen, Germany
,
A. Königsrainer
2   University Hospital Tübingen, Department of General, Visceral and Transplant Surgery, Tübingen, Germany
,
N. P. Malek
1   University Hospital Tübingen, Medical Clinic, Department of Gastroenterology, Hepatology, and Infectiology, Tübingen, Germany
,
U. M. Lauer
1   University Hospital Tübingen, Medical Clinic, Department of Gastroenterology, Hepatology, and Infectiology, Tübingen, Germany
,
C. P. Berg
1   University Hospital Tübingen, Medical Clinic, Department of Gastroenterology, Hepatology, and Infectiology, Tübingen, Germany
› Author Affiliations
Further Information

Publication History

29 October 2013

09 December 2013

Publication Date:
13 January 2014 (online)

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Abstract

Recurrent HCV infection post-liver transplantation (post-LT) is still a major challenge in the treatment of hepatitis C virus (HCV) infection. In this retrospective analysis we gathered data about treatment response and safety of all 14 post-LT patients who were treated between 2011 and 2013 at our centre with a telaprevir (TVR)-based triple therapy. Seven out of 14 patients completed the full treatment course of 48 weeks. Five patients achieved a SVR 24, while 3 additional HCV RNA-negative patients are still in follow-up (end of treatment, SVR 12 and 22). Four patients discontinued treatment prematurely due to side effects. A virological non-response at TW 4 was seen in 1 patient. Virological breakthrough was observed in 2 patients at TW 16 and 28, respectively; 1 patient displayed a virological relapse after the end of treatment (EOT). Patients with a complicated course post-LT accumulated most of the severe side effects, largely infections. One patient with cholestatic hepatitis died 11 weeks after discontinuation of treatment due to progressive graft failure. In conclusion, TVR-based triple therapy in post-LT patients reveals an acceptable antiviral efficacy. Unfortunately, severe side effects are frequent and often require therapeutic interventions. Therefore, with the approval of less straining DAA like sofosbuvir in sight, TVR-based triple therapy in post-LT patients should be, if possible avoided.

Zusammenfassung

Die Hepatitis-C-Reinfektion des Spenderorgans nach einer Lebertransplantation ist nach wie vor eine klinische Herausforderung. In dieser retrospektiven Analyse wurden daher die Tübinger Erfahrungen mit der Telaprevir-Triple-Therapie anhand des Gesamtkollektivs von 14 behandelten Patienten zwischen 2011 und 2013 zusammengefasst. Sieben der 14 Patienten konnten über die volle Therapiedauer von 48 Wochen therapiert werden. Bisher konnten fünf Patienten geheilt werden (SVR 24), drei weitere Patienten sind noch in der Nachsorgephase („end of treatment“, SVR 12 bzw. 22). Vier Patienten brachen wegen Nebenwirkungen die Therapie ab. Ein Patient hatte ein primäres virologisches Nichtansprechen, zwei Patienten hatten einen „breakthrough“, ein Patient erlitt einen „relapse“ nach Beendigung der vollen Therapiedauer. Patienten mit komplikativem Verlauf nach Lebertransplantation erlitten den Großteil der teils schwerwiegenden Nebenwirkungen, oft Infektionen. Ein Patient mit cholestatischer Rekurrenz der Hepatitis C verstarb 11 Wochen nach Therapieabbruch an den Folgen eines progredienten Transplantatversagens. Insgesamt lassen sich mit der Telaprevir-Triple-Therapie auch nach Lebertransplantation respektable Heilungsraten erzielen. Leider sind schwerwiegende und die Therapie teils limitierende Nebenwirkungen häufig. Somit sollte eine solche Therapie insbesondere vor dem Hintergrund der nahenden Zulassung weniger belastender Direct-Acting-Agent (DAA) wie Sofosbuvir nach Möglichkeit vermieden werden.

Schlüsselwörter

Hepatitis C - Lebertransplantation - SVR - Telaprevir - Nebenwirkungen - cholestatische Rekurrenz der Hepatitis C

Key words

hepatitis C - liver transplantation - SVR - telaprevir - side effects - fibrosing cholestatic hepatitis
 

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