Treatment of Hepatitis C in the Post Liver Transplant Patient

Abstract

Introduction: Hepatitis C virus (HCV) remains the most common indication for liver transplantation. Recurrence of HCV occurs in about 95% of patients after liver transplant. The course of HCV infection can be accelerated in post-transplant patients with 10-20% developing cirrhosis within five years. Successful treatment of HCV post-transplant may significantly improve overall survival of these patients. In this study, we aimed to evaluate the effects of ribavirin on treatment. Methods: A previously collected list of post-transplant patients with HCV was reviewed. The collected data included demographic information, time from transplant to treatment, viral load, treatment regimen, sustained virologic response (SVR), genotype, and pertinent laboratory values. Data were analyzed to compare SVR across different treatment regimens. Results: A total of 71 patients who underwent liver transplant at our institution were reviewed. SVR data was available for 44 at the time of the review. We treated a total of 32 male patients and 12 female patients with a mean age of 60 years. Of the 44 patients, 12 patients were treated within one year of transplant (three patients within three months). Forty of forty-four patients (91%) achieved SVR. Of the four patients who did not achieve SVR, three were treated with ledipasvir/sofosbuvir for 12 weeks (all genotype 1) and one was treated with sofosbuvir/ribavirin for 12 weeks (genotype 2b). The SVR rate for ledipasvir/sofosbuvir was 17/20 (85%) while the SVR rate for ledipasvir/sofosbuvir and ribavirin was 12/12 (100%). Ribavirin was used to treat 16 of the 44 patients. The SVR rate with ribavirin containing regimens was 15/16 (94%) vs. 25/28 (89%) without ribavirin. Of the 16 patients on ribavirin, seven (44%) had to discontinue ribavirin; five due to anemia, one due to fatigue and diarrhea, and one for unknown reasons. Thirteen of sixteen patients treated with ribavirin had genotype 1 disease and the other three had genotype 2b. Conclusion: Recurrent HCV is a common problem in the post liver transplant patient and can be a cause of significant morbidity. Successful treatment of HCV has become more common and this has been applied to the post liver transplant population. Our small series shows that high rates of SVR are possible in this population even without the addition of ribavirin. The treatment of HCV is both successful and well tolerated in the early post-transplant period.