The Treatment of Hepatitis C Virus (HCV) with Direct Acting Antiviral (DAA) Treatment in the Post Orthotopic Liver Transplant (OLT) Patient Is Safe and Efficacious

Purpose: Chronic HCV is one of the leading causes for end stage liver disease and liver transplantation. Since their introduction, DAAs have revolutionized the treatment of HCV, however limited real-world data exists regarding their use in the post OLT patient. We assessed the efficacy and safety of sofosbuvir/velpatasvir (Epclusa), elbasvir/grazoprevir (Zepatier), glecaprevir/pibrentasvir (Mavyret) and sofosbuvir/velpatasvir/voxilaprevir (Vosevi) in post OLTpatients at a diverse, urban, tertiary center clinical setting. Methods: All OLT patients treated with Epclusa, Zepatier, Mavyret or Vosevi therapy between January 2016 until June 2018 that were at least 12 weeks out from treatment were assessed. Background information collected included age, gender, race, BMI and prior HCV treatment. Primary outcome was undetectable HCV RNA levels at post treatment week 12 (SVR12). Secondary outcomes included changes in renal function, liver function, immunosuppression levels and adverse events during treatment. Results: Seventeen patients underwent post OLT HCV therapy with either Epclusa (13), Zepatier (1) Mavyret (2) or Vosevi (1). Of which, 16 (94%) completed treated and were at least 12 weeks out from treatment. One patient was withdrawn from analysis as treatment with Mavyret was discontinued after developing hyperbiliru-binemia. The final group was composed predominantly of treatment-naive (63%), Caucasian (75%) males (75%). HCV genotypes included la (5), lb (2), 2b (2), and 3 (7). Fifteen patients (94%) were treated for 12 weeks while 1 patient (6%) was treated for 24 weeks. After completion of treatment, all patients achieved SVR12. During therapy, all patients needed adjustments in their immunosuppression levels (tacrolimus or evero-limus). Five patients (31%) developed AKI (defined as rise in serum creatinine \u3e0. 3 mg/dL from pretreatment baseline creatinine) inter-treatment. Of which, 4 patients (80%) had renal recovery back to baseline pre-treatment labs. One patient (6%) developed chronic cellular rejection within 12 weeks of completing DAA therapy. Treatment related adverse effects included anemia, fatigue, nausea and vomiting. Conclusions: DAA therapy with Epclusa, Zepatier, Mavyret and Vosevi was safe and effective in this cohort of patients for treatment of chronic HCV in the post OLT patient with high SVR rates and low side effect profiles. Frequent monitoring of renal function, liver chemistries and immunosuppression levels during treatment is advised. Further follow up is needed to assess long term outcomes