Herzer Kerstin, Papadopoulos-Köhn Angela, Achterfeld Anne, Canbay Ali, Piras-Straub Katja, Paul Andreas, Walker Andreas, Timm Jörg, Gerken Guido
Kerstin Herzer, Angela Papadopoulos-Köhn, Anne Achterfeld, Ali Canbay, Katja Piras-Straub, Guido Gerken, Department of Gastroenterology and Hepatology, University Hospital Essen, 45122 Essen, Germany.
World J Hepatol. 2015 May 28;7(9):1287-96. doi: 10.4254/wjh.v7.i9.1287.
To characterize management of telaprevir (TVR)-based triple therapy of hepatitis C virus (HCV) reinfection after liver transplantation (LT).
We retrospectively analyzed safety and efficacy of telaprevir - based triple therapy in a single center cohort of 19 patients with HCV genotype (GT) 1 recurrence after LT, with respect to factors possibly predicting sustained viral response (SVR) or non-SVR. All patients were treated with TVR, pegylated (PEG) and ribavirine (RBV) for 12 wk followed by a dual phase with PEG/RBV for 12 wk in 7 patients and for 36 wk in 5 patients.
In total 11/19 (58%) of patients achieved a sustained response. All (11/11) SVR patients showed a rapid viral response at treatment weeks 4 and 11/14 rapid virological response (RVR) patients achieved SVR. Notably, all (7/7) patients who completed 48 wk of therapy and 80% (4/5) patients who completed 24 wk of therapy achieved SVR24. Treatment failure was significantly (P > 0.049) more frequent in GT1a infection (5/7) compared to GT1b (3/12) infection and was associated with emergence of resistance-associated mutations in the NS3 protease domain. Bilirubin level at baseline is also related to SVR (P > 0.030). None of the patients had to discontinue treatment due to side effects.
RVR, GT and bilirubin are clearly related to achievement of SVR. Providing a thorough patient selection and monitoring, a full course of TVR-based triple therapy in LT patients is feasible and achieves high SVR rates.
描述基于替拉普韦（TVR）的丙型肝炎病毒（HCV）肝移植（LT）后再感染三联疗法的管理。
我们回顾性分析了单中心队列中19例LT后HCV基因（GT）1型复发患者基于替拉普韦的三联疗法的安全性和有效性，涉及可能预测持续病毒学应答（SVR）或非SVR的因素。所有患者接受TVR、聚乙二醇化（PEG）和利巴韦林（RBV）治疗12周，随后7例患者接受PEG/RBV双药治疗12周，5例患者接受36周。
总共11/19（58%）的患者实现了持续应答。所有（11/11）SVR患者在治疗第4周显示出快速病毒应答，11/14快速病毒学应答（RVR）患者实现了SVR。值得注意的是，所有（7/7）完成48周治疗的患者和80%（4/5）完成24周治疗的患者实现了SVR24。与GT1b（3/12）感染相比，GT1a感染（5/7）的治疗失败明显更频繁（P>0.049），并且与NS3蛋白酶结构域中耐药相关突变的出现有关。基线胆红素水平也与SVR相关（P>0.030）。没有患者因副作用而不得不停止治疗。
RVR、GT和胆红素与SVR的实现明显相关。通过进行全面的患者选择和监测，LT患者接受基于TVR的三联疗法全疗程是可行的，并能实现高SVR率。
