Has anyone heard if they are treating transplant recp. with new medicine yet. I go back 2 dr. on the 29th.

[nicki1953]

Good morning everyone. I have had a liver transplant, in 2009. Was doing good till the Hep C got real active again. Now I am tired and weak again, need the treatment again. I go to see my Dr. On the 29th, am going to ask about the new medicine that is out. But was wondering if anyone heard about them using it on transplant recepitants. Thanks

[mikesimon]

Is Cellcept the only immunosuppressive he's currently taking? My understanding is that Cellcept is usually combined with another drug - a calcineurin inhibitor for example.

It seems unlikely and perhaps dangerous to stop all anti-rejection drugs and initiate treatment for HCV. It sounds like fertile ground for acute organ rejection so I assume he is going to take some kind of immunosuppressive drug. Any information would be welcome Hector.

Mike

[HectorSF]

Mike I talked to my friend Jim who starts INCIVEK 3 meds on Oct 12th.

He will be stopping his CellCept (Mycophenolate (Myfortic)) before starting treatment as you suspected due to interactions with INCIVEK.
He is almost 2 years post transplant now.

I hope this helps.
I will let you know how things go for him as I will be helping him make it through treatment.

Cheers!
Hector

[HectorSF]

Hi Mike.

Here is an interesting article that backs up what you said about treating post transplant patients.

"Telaprevir, boceprevir, cytochrome P450 and immunosuppressive agents - A potentially lethal cocktail (see article below editorial) - Editorial "

http://www.natap.org/2011/HCV/071211_02.htm

"Finally, telaprevir has not been studied in pre-, post-, or peritransplant patients. The degree of the interaction with calcineurin inhibitors reported here suggests potential implications for patient safety. Telaprevir should not be administered to these patients, because the required studies have not been completed to understand appropriate dose adjustments needed for safe coadministration of telaprevir with cyclosporine or tacrolimus, and regulatory approval has not been obtained."

HEPATOLOGY, July 2011

Michael Charlton, MD, FRCP, Department of Gastroenterology and Hepatology, Mayo Clinic Transplant Center CH-10, Mayo Clinic, 200 First St. S.W., Rochester, MN. 55905. E-mail: charlton.michael@ mayo.edu; Fax: [phone].

Remember this was phase 1 with healthy volunteers NOT TP patients.
Hector

[SusieS2010]

One of the ladies on my board who is 16 months post transplant is starting with triple therapy very shortly. I believe her transplant center is in St. Louis.

[nicki1953]

Thank you very much for all of your replys. I am going to ask my liver doctor about it again on the 29th, will let you know what they say. Again thanks.

[HectorSF]

Mike, I'll ask Jim if he knows of any changes. He may not know until he starts treating. (He just had his eyes checked today).
I'll ask him is a few days and get back to you.
If you don't hear from me. Just remind me again.

I haven't seen a word anywhere else either. I was suppose to starting treating myself with the DAAs but since I developed HCC, the cancer is the primary focus right now. I probably won't have the treatment until right before transplant now so as to try to avoid hepatitis C from reoccurring in my new donor liver. The whole idea of trying to save my current liver is a mute point now. My cancerous liver will kill me if I don't get a donor liver in the near future. I hope to make it to transplant in the next year-year and a half and hope my cancer stays controlled until then.

Cheers!
Hector

[mikesimon]

I'm sorry to hear about your HE.

I've been on the alert for any information on this issue and I haven't seen a thing.

I visited your transplant clinic's site and if they're doing a trial they aren't saying a word about it.

From the little I know about it I would want more than 2 blood draws per week at least until the PI's effect on my Prograf plasma levels were clear.

Would you ask your friend whether they are reducing his anti-rejection dose and, if so, by how much? If he is taking a calcineurin inhibitor I'd expect some kind of dose reduction.

I hope you feel better Hector.
Mike

[HectorSF]

Sorry no data. But I will be happy to share whatever I learn. A very good friend of mine who is almost 2 years "post" will be starting treatment very soon with my doc who leads the viral hepatitis studies at the transplant center. The one thing that I know so far is he will have blood tests twice weekly to monitor his progress.

I will be helping him through DAA treatment and he and his family will be helping me with my liver cancer treatment (December?) and transplant (a year to 1 1/2 years down the road). We are going to the liver transplant support group today at UCSF. If I hear of anyone else who is treating I will try to stay in touch with them also.

As I learn more I will post it.

You can also send me a PM now and then to remind me. (encephalopathy is pretty bad these days).

Take care Mike.
Hector

[mikesimon]

Do you have any links to information about treating transplant recipients or trials for transplant recipients with either Incivek or Victrelis?
I'd like to see anything you have on this issue.

Thanks,
Mike

[HectorSF]

As Lynda said, the treatment of post transplant patients with the new DAAs is off-label.

Hector

[HectorSF]

I am sorry to hear that your hepatitis C is damaging your new liver.

Yes, post transplant patients are being treated with the new drugs at least at my transplant center. (U.C. at San Francisco) The patients have just started treatment so there is no data regarding results. Figure at least a year or so for the data to be available. I haven't heard of other centers doing the same but I'm sure some of the other top liver transplant programs are also trying the new treatments at least on a few well selected patients.

You need to talk to your hepatologist at your transplant center and see if they are treating with the new DAAs and your are a candidate or still using only peg-IFN and ribavirin. Remember, your transplant center is still in charge of your health and needs to determine what is best for you and your new liver. They will determine your options.

Here is a link to a good article on post transplant hepatitis C...
"Hepatitis C virus (HCV)-associated liver disease after liver transplantation"
http://www.news-medical.net/news/20110608/Hepatitis-C-virus-%28HCV%29-associated-liver-disease-after-liver-transplantation.aspx

Congratulations on your transplant and good luck with your treatment!
Hector

[mikesimon]

I don't believe that OH is treating with a PI.
The PIs can increase plasma levels of tacrolimus and cyclosporine very significantly - to toxic levels. There's a lot of research regarding dosing that needs to be done before these drugs will be used in the transplant population.

Mike

[nygirl7]

Ah well...I tried...OH is the only tp recip I can remember who is retreating (I believe).

[lynda607]

I think the PI's are currently being trialed for transplant recipients but so have not been approved for use in those who have been transplanted.

[nygirl7]

I believe a member here Orphan Hawk who was transplanted and is a geno1 is retreating with the PI on board.