Prevention of hepatitis C recurrence by bridging sofosbuvir/ribavirin from pre‐ to post‐liver transplant: a real‐life strategy

Background & Aims Hepatitis C virus ( HCV ) re‐infection following liver transplant ( LT ) is associated with reduced graft and patient survival. Before transplant, Sofosbuvir/Ribavirin ( SOF /R) treatment prevents recurrent HCV in 96% of those patients achieving viral suppression for at least 4 weeks before transplant. We evaluated whether a bridging SOF ‐regimen from pre‐ to post‐transplant is safe and effective to prevent HCV recurrence in those patients with less than 4 weeks of HCV ‐ RNA undetectability at the time of transplant. Methods From July 2014 SOF /R was given in 233 waitlisted HCV cirrhotics with/without hepatocellular carcinoma ( HCC ) within an Italian Compassionate Program. One hundred patients were transplanted and 31 patients (31%) treated with SOF /R bridging therapy were studied. Results Liver transplant indication in bridge subgroup was HCC in 22 and decompensated cirrhosis in 9. HCV ‐genotype was 1/4 in 18 patients. SOF 400 mg/day and R (median dosage 800 mg/day) were given for a median of 35 days before LT . At transplant time, 19 patients were still HCV ‐ RNA positive (median HCV ‐ RNA 58 IU/mL). One recipient had a virological breakthrough at week 4 post‐transplant; one died, on treatment, 1‐month post‐transplant for sepsis and 29/31 achieved a 12‐week sustained virological response (94%). Acute cellular rejection occurred in three recipients. On September 2016, 30 recipients (97%) were alive with a median follow‐up of 18 months (range 13‐25). Conclusions In patients with suboptimal virological response at LT , a bridging SOF /R regimen helps avoiding post‐transplant graft reinfection.