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Management of HCV transplant patients with triple therapy
Author(s) -
Coilly Audrey,
Roche Bruno,
DuclosVallée JeanCharles,
Samuel Didier
Publication year - 2014
Publication title -
liver international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.873
H-Index - 110
eISSN - 1478-3231
pISSN - 1478-3223
DOI - 10.1111/liv.12406
Subject(s) - telaprevir , boceprevir , medicine , ribavirin , liver transplantation , cirrhosis , pegylated interferon , liver disease , hepatitis c virus , hepatitis c , gastroenterology , decompensation , calcineurin , sofosbuvir , transplantation , immunology , virus
Abstract Hepatitis C virus ( HCV ) infection is one of the leading causes of end‐stage liver disease and the main indication for liver transplantation ( LT ) in most countries. All patients who undergo LT with detectable serum HCV RNA experience graft reinfection. Between 20 and 30% of patients have developed cirrhosis at 5 years post‐ LT . The outcome of transplant patients with cirrhosis on the graft is severe, with a rate of decompensation at 1 year of approximately 40%. To date, retransplantation is the only option in patients with decompensated liver disease. Until 2011, standard antiviral therapy with pegylated interferon ( PEG ‐ IFN ) and ribavirin ( RBV ), was the only effective therapy. Obtaining a sustained virological response ( SVR ) in patients with LT greatly improves overall and graft survival but this only occurs in 30% of transplanted patients. Direct acting antivirals ( DAA s) such as protease inhibitors ( PI ), polymerase or other non‐structural proteins inhibitors represent a new era in HCV associated liver disease. Although their use in the field of LT will certainly be essential there are some limitations because of safety and tolerance. One limitation is the potential interaction with calcineurin inhibitors. We describe the results of triple therapy with boceprevir ( BOC ) or telaprevir ( TVR ) for efficacy and safety and comment on future therapeutic strategies in liver transplant recipients.