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Bridging all oral DAA therapy from wait time to post-liver transplant to improve HCV eradication?
Maria Francesca Donato1, Sara Monico, Federica Malinverno
1Gastroenterology and Hepatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan, Italy.
Insights
Hepatitis C virus (HCV) recurrence post-liver transplant (LT) is a significant issue. Sofosbuvir and ribavirin treatment before and after LT achieved sustained virologic response (SVR24) in a re-transplanted patient, highlighting its efficacy.
Area of Science:
- Hepatology
- Transplant Surgery
- Virology
Background:
- Recurrent hepatitis C virus (HCV) infection post-liver transplant (LT) leads to graft loss and reduced survival.
- Eradicating HCV infection through antiviral therapy before or after LT is crucial for improving outcomes.
- Direct-acting antiviral (DAA) interferon-free regimens offer high efficacy for HCV eradication in LT recipients.
Observation:
- A patient with decompensated cirrhosis due to recurrent HCV underwent re-LT.
- Treatment with sofosbuvir and ribavirin commenced during the waiting period and continued throughout the transplant and post-transplant phases for 24 weeks.
- The patient provided informed consent for the sofosbuvir plus ribavirin therapy.
Findings:
- Post-transplant serum HCV RNA remained undetectable 24 weeks after completing sofosbuvir and ribavirin treatment (SVR24).
Implications:
- Sofosbuvir plus ribavirin is recommended as a first-line treatment for patients awaiting LT.
- Bridging HCV treatment into the post-transplant period is suggested if undetectable HCV RNA is not achieved before LT.
- This approach may improve graft and patient outcomes in challenging LT scenarios.
Background & Aims:
Recurrence of hepatitis C is a major cause of graft loss and shortened survival in patients receiving a liver transplant (LT) for end-stage hepatitis C virus (HCV) infection. The only way to improve graft and patient outcomes is a successful eradication of HCV infection by antiviral therapy either before or after transplant. This was achievable in a small proportion of recipients by IFN-based regimens, but could be obtained in the majority of them by using DAA IFN-free regimens before/after transplant.
Methods:
We describe a patient with decompensated cirrhosis because of severe recurrent hepatitis C, who had a retransplant following treatment with a combination of sofosbuvir and riba virin that started during the waiting time and was carried over during both the transplant and post-transplant phases for an overall period of 24 weeks. The patient gave a written consent to receive Sofosbuvir plus Rbv therapy pre and post-transplant.
Results:
Post-transplant serum HCV-RNA remains undetectable 24 weeks after discontinuing sofosbuvir and ribavirin (SVR24).
Conclusions:
Waiting for direct antiviral agents combinations, our findings not only support the use of sofosbuvir plus ribavirin as the first-line treatment in all patients on the LT waiting list, but also suggest to bridge treatment to the post-transplant period in case HCV RNA undetectability for at least 30 days has not been achieved at the time of LT.
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