Sofosbuvir-based antiviral therapy in patients with recurrent HCV infection after liver transplant: A real-life experience

Introduction and aim: Recurrent HCV infection after liver transplant (LT) has a negative impact on graft and patient survival. The aim of this study is to describe the efficacy and safety of sofosbuvir (SOF-based) regimens in the treatment of recurrent HCV after liver transplant (LT). Materials and methods: This retrospective study included 68 adults with recurrent HCV infection after LT, treated with different SOF-based regimens between March 2015 and December 2016. The choice of regimens, their duration and use of ribavirin (RBV) was made by the treating physician. The efficacy of antiviral treatment was assessed based on the sustained viral response obtained 12 weeks after the end of treatment (SVR12), according to an intention-to-treat analysis. Results: The most frequent HCV genotypes were 1 and 3 (n = 35, 51.4% and n = 31, 45.6%, respectively). Only 22 patients were treatment naïve (32.3%) and 7 had cirrhosis (10.2%). SOF + daclatasvir (DCV) was the most commonly used regimen (n = 63, 92.6%). Most patients used RBV (n = 56, 82.3%) and were treated for 12 weeks (n = 66, 97%). Overall SVR12 was 95.5% (65/68 patients). Three patients had virologic failure. Three patients had serious adverse events, however, no one discontinued treatment prematurely. RBV-related anaemia was the most frequent adverse event (n = 34, 50%). Four patients had severe cellular graft rejection after HCV elimination, while immunosuppression remained stable. Conclusion: SOF-based therapy is highly effective and safe to treat HCV recurrence after LT. Cellular graft rejection following the successful treatment of HCV needs further investigation