Abstract
Recurrent hepatitis C (HCV) after liver transplantation (LT) is an important cause of morbidity and mortality. Antiviral treatment is recommended to avoid unfavorable outcomes. Direct-acting antivirals (DAA) have transformed HCV treatment, with higher efficacy and fewer side-effects than interferon-based therapies traditionally used. To evaluate DAA treatment outcomes at a Brazilian transplant unit, data of patients who finished HCV treatment at the Liver Transplant Unit of the University of Campinas were analyzed. Treatment consisted of sofosbuvir, daclatasvir, and ribavirin, for 12 or 24 weeks, according to the national guidelines. Fifty-five patients completed antiviral treatment and 54 had HCV-viral load results available. The majority of patients were male (78%), 58 years old on average, 65% had hepatocellular carcinoma (HCC) before LT, and 67% were interferon treatment-experienced. Most patients had HCV genotype 1 (65%), 35% had genotype 3, and started treatment on an average of 38 months after LT (range: 2–228). Fifty-eight percent were treated for 12 weeks and 42% for 24 weeks, using a mean dose of ribavirin of 10.1 mg/kg (4.2–16.1). There were no treatment interruptions due to serious side effects. The sustained virological response rate was 98%. Only one patient relapsed, a genotype 3 cirrhotic treated for 12 weeks. The average follow-up after starting antivirals was 20 months. There were no recurrences of HCC, but there was one rejection episode and one cirrhosis decompensation episode, both 12 weeks after treatment. DAA treatment is safe and effective in the post-LT setting and was not associated to HCC recurrence in the cohort studied.
Highlights
Hepatitis C virus (HCV) is the main cause of liver transplantation (LT) worldwide and has universal recurrence [1,2]
One patient was excluded due to chronic kidney disease with a glomerular filtration rate (GFR) of less than 30 mL Á min-1 Á (1.73m2)-1 and one patient was excluded because he was diagnosed with metastatic squamous cell carcinoma and discontinued antiviral treatment
One patient had cirrhosis decompensation, with esophageal variceal bleeding, ascites, encephalopathy, and jaundice occurring twelve weeks after end of treatment (EOT) (Table 4). This real-life study in Brazilian liver transplant recipients confirmed the results of international clinical trials, demonstrating the dramatic improvement in sustained virological response (SVR) rates that direct acting antivirals (DAA) therapy has brought compared to traditional interferon-based therapy
Summary
Hepatitis C virus (HCV) is the main cause of liver transplantation (LT) worldwide and has universal recurrence [1,2]. It can lead to cirrhosis and graft loss in one third of patients within five years of LT, which justifies the reduced survival rates observed when comparing HCV to other causes of LT [2]. The progression of liver fibrosis is accelerated in the post-LT population [3] and its treatment is considered a priority, since antiviral therapy can be used to prevent liver damage and, prolong survival [4,5,6]. Therapeutic options, once dependent on interferon and reaching 30% SVR rates, are based on direct acting antivirals (DAA), drugs with better tolerability, reduced side effects, and optimized response rates, with overall SVR rates post-LT higher than 90% [7,8,9,10,11,12,13,14]. The optimal drug regimen, duration, and timing of treatment are the issues faced by physicians in the DAA era
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