Evaluation of Different Regimens of New Direct Acting Antiviral drugs (DAAs) for treatment of Recurrent Hepatitis C Virus Infection after Liver Transplantation

Abstract

Abstract Aim of the work To compare between different available regimens of DAAs (sofosbuvir/ daclatasvir and sofosbuvir / ledipasvir) regarding the efficacy and safety for treatment of compensated recurrent hepatitis C Virus infection after liver transplantation in Egyptian patients and to study the correlation between sofosbuvir / daclatasvir and sofosbuvir / ledipasvir and post-transplant complications. Background Liver transplantation is the only curative treatment for ESLD and HCC. Liver disease resulting from chronic HCV infection is the leading indication for liver transplantation. For patients with detectable HCV-RNA levels at the time of transplantation, postoperative recurrence of HCV infection was “immediate and universal.” Recurrent HCV infection follows an aggressive course and retransplantation frequently is associated with a poor outcome. Patients and Methods This prospective study was conducted on recipients, who underwent living donor liver transplantation in Ain Shams Center for Organ Transplantation (ASCOT) at Ain Shams University Specialized Hospital (ASUSH), Cairo, Egypt between June, 2016 and May, 2017. Data of the recipients, who underwent living donor liver transplantation during the study period, were reviewed and the patients who fulfilled the inclusion criteria were enrolled into this study. The patients who fulfilled the inclusion criteria and received antiviral treatment were followed up monthly during their treatment and after finishing treatment for at least 3 months. Results Treatment of HCV recurrence in liver transplant recipients with SOF+DCV+RBV or SOF/LDV+RBV seems to confer high rates of SVR. There was no difference between both regimens regarding adverse events. Prolonged treatment of HCV recurrence after LDLT (24 weeks) was significantly associated with a higher SVR (P = 0.035). Conclusion Adding RBV to antiviral regimens in the treatment of HCV recurrence in liver transplant recipients doesn’t seem to add to the efficacy of DAAs. Adherence to prolonged course of antiviral treatment (6 months) when treating HCV recurrence post liver transplantation seems to be associated with higher rates of SVR than shorter course (3 months) with no increase in the incidence of adverse events or rejection episodes.