Sustained Viral Response after Treatment with Ledipasvir/Sofosbuvir (Harvoni®) in a Patient with Hepatitis C Following Intestine and Renal Transplantation

Abstract

Introduction: Sustained viral response (SVR) following treatment with Ledipasvir and Sofosbuvir (Harvoni®-Gilead Sciences, CA) for chronic hepatitis C (HCV) is well documented in liver transplantation (TX). There is no report of SVR following treatment with Harvoni® in a patient after intestine TX (ITx). We report a case of an adult with HCV genotype 1A, treated with Harvoni® for 12 weeks post intestine-kidney transplantation (IKTX) who achieved SVR 3 months after treatment. Method: Retrospective review of patient with HCV who underwent IKTX at a quaternary level ITX center. Results: Case report: We report a 40 year old male with hypertension (HTN), severe coronary artery disease (CAD), Hepatitis C (HCV) and end stage renal disease (ESRD) due to hemolytic uremic syndrome (HUS). He was diagnosed with HCV, genotype 1a in 2000. Prior to initial presentation, patient was on peritoneal dialysis and developed progressive sclerosing peritonitis with 2 failed attempts at small bowel and ileo-colonic resection for recurrent intestinal obstruction. Patient was switched to hemodialysis (HD) and with continued enteral intolerance and failure to thrive, was commenced on TPN and listed for combined IKTX. Decision was made to not treat the HCV prior to TX due to ESRD and decreased absorption due to intestinal failure from sclerosing peritonitis. Safety and efficacy of Harvoni has only been established in patients with GFR >30, and there are no guidelines on safety and efficacy in patients on HD. Liver biopsy 18 months prior to IKTX, showed portal fibrosis (gr1, stage 1). Liver biopsy at time of IKTX showed worsening fibrosis (gr 2, stage 2), suggesting progression of HCV. Patient underwent IKTX in January 2015. Post-IKTX course was uncomplicated with normal renal and intestinal allograft function. Patient did not require further dialysis after IKTX and was weaned off TPN rapidly. He was treatment naïve and started on Harvoni® 8 months after IKTX. HCV PCR had increased from 2.9 million copies pre-IKTX, to 14.1 million copies at start of treatment (Figure 1). He tolerated 12 weeks of Harvoni® with no adverse effects or impact on IKTX allograft function. Viral load was undetectable at treatment completion.FigureConclusion: This report suggests that treatment with Harvoni® is a viable treatment option for HCV following ITX. This case illustrates potential to successfully treat patients with HCV and porto-mesenteric venous thrombosis who may be candidates for multi-visceral TX.