Abstract
BackgroundLiver transplant population has been considered as a special population in the treatment of hepatitis C virus infection, not only because of lower sustained virological response (SVR) rates in comparison with pretransplant setting, but also for other aspects (i.e., immunosuppressive therapy, renal function, drug–drug interactions). We aimed to evaluate the efficacy and safety of the combined treatment with sofosbuvir and daclatasvir with or without ribavirin in liver transplant recipients with recurrent hepatitis C following transplantation and screening for the development of hepatocellular carcinoma during treatment, after the end of treatment, or during follow-up. This multicenteric prospective study was conducted in Egypt. This study included 40 patients who underwent living donor liver transplantation that started treatment at least 3 months following transplantation. All participants received 400 mg sofosbuvir once daily plus daclatasvir 60 mg daily ± ribavirin. Treatment lasted for up to 24 weeks, and participants were followed up as outpatients monthly for 12 and 24 weeks and 36 weeks post-treatment to determine sustained virological response (SVR12 and SVR24), considered to be a cure and detection of any changes in tumor markers or radiological imaging during follow-up.ResultsIn the current study, 40 patients (100%) have good response to treatment during treatment and during follow-up (SVR 12 was 100%). No abnormal side effects to treatment were detected; also, no drug–drug interactions were noted during the treatment.ConclusionsTreatment of HCV after living donor liver transplantation with combined sofosbuvir and daclatasvir is safe and well-tolerated and provides high rates of SVR.
Highlights
Liver transplant population has been considered as a special population in the treatment of hepatitis C virus infection, because of lower sustained virological response (SVR) rates in comparison with pretransplant setting, and for other aspects
End-stage liver disease (ESLD) caused by hepatitis C virus (HCV) infection is the main indication of liver transplantation (LT) in most transplant programs [1]
Most patients will go on to develop viral recurrence, and it has been widely appreciated that the clinical course of HCV in LT recipients is accelerated in comparison with
Summary
Liver transplant population has been considered as a special population in the treatment of hepatitis C virus infection, because of lower sustained virological response (SVR) rates in comparison with pretransplant setting, and for other aspects (i.e., immunosuppressive therapy, renal function, drug–drug interactions). We aimed to evaluate the efficacy and safety of the combined treatment with sofosbuvir and daclatasvir with or without ribavirin in liver transplant recipients with recurrent hepatitis C following transplantation and screening for the development of hepatocellular carcinoma during treatment, after the end of treatment, or during follow-up. This multicenteric prospective study was conducted in Egypt. When treating hepatitis C in this setting, the main goals of therapy include (a) cure of HCV chronic infection in the allograft post-transplant; (b) minimize the risk of developing HCV-associated complications in the allograft, such as fibrosing cholestatic hepatitis and allograft failure; and (c) prevent the development of hepatic fibrosis and preserve the function of the transplanted liver [4].
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