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Bridging all oral DAA therapy from wait time to post‐liver transplant to improve HCV eradication?
Author(s) -
Donato Maria Francesca,
Monico Sara,
Malinverno Federica,
Aghemo Alessio,
Maggioni Marco,
Reggiani Paolo,
Colombo Massimo
Publication year - 2015
Publication title -
liver international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.873
H-Index - 110
eISSN - 1478-3231
pISSN - 1478-3223
DOI - 10.1111/liv.12646
Subject(s) - medicine , sofosbuvir , ribavirin , hepatitis c virus , cirrhosis , hepatitis c , antiviral therapy , liver transplantation , gastroenterology , transplantation , virus , immunology , chronic hepatitis
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 ( SVR 24). 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 .