Efficacy of Sofosbuvir-Based Anti-Viral Therapy in Preventing Post-Transplant Recurrence of HCV

Abstract

Introduction: Hepatitis C virus (HCV) infection is a leading cause of end-stage liver disease in Pakistan and the most common indication for liver transplantation in the country. Recurrence of HCV infection following liver transplantation leads to accelerated fibrosis and progression to cirrhosis. Rates of graft loss and patient mortality also are markedly higher for patients with recurrent HCV than for uninfected patients. Retransplantation frequently is associated with a poor outcome. Sofosbuvir is a nucleotide polymerase inhibitor of NS5B-directed HCV-RNA replication. Administration of sofosbuvir with ribavirin is associated with rapid decreases of HCV RNA to undetectable levels in patients with HCV genotype 1, 2, 3, 4, and 6 infections.This study aimed at investigating the efficacy of Sofosbuvir based anti-viral therapy in post-transplant patients with recurrent HCV infection Methods: This was a retrospective analysis of medical records of patients who had received Sofosbuvir based combinations to treat active viral infection in the post-transplant setting Response to therapy was determined via SVR 12 and SVR 24. Patients aged 18 to 80 were included in this study. Patients with HCV/ HBV coinfection, CKD with eGFR < 30 ml/ min and HCV/ HIV co-infection were excluded. Data was collected using a structured questionnaire in 25 patients (21 males and 4 females). Frequencies and percentages were calculated to examine the responses Results: The results of the study showed that amongst patients who had started treatment within one year post transplant, SVR12 was achieved by in 95%, and SVR24 was achieved in 90%.of the patients. Moreover, the findings showed meaningful correlation of SVR12 and SVR24 with a93% concordance. Among those patients (2/25-8%) that were unable to achieve SVR12 or end of treatment response the main factor was lack of compliance or discontinuation of treatment. Conclusion: The sofosbuvir based anti-viral therapy in post-transplant patients is effective and safe in preventing HCV recurrence. Treatment of HCV in the post-transplant period can lead to better outcomes and should therefore be offered to all patients.