Early treatment of recurrent hepatitis C virus infection after liver transplantation in the era of direct-acting antivirals, what we have learned till now?

Abstract

© 2018 Egyptian Liver Journal. Background and aims Recurrent hepatitis C virus (HCV) after liver transplantation (LT) is universal. According to the most recent guidelines, treatment for recurrent HCV after LT should be initiated early after LT, ideally as early as possible when the patient is stabilized. The aim of this study was to evaluate the efficacy, safety, and tolerability of several direct-acting antivirals (DAAs) in LT recipients with recurrent HCV genotype 4 and to compare results of sustained virological response (SVR) between those who were treated early after 3 months with those who were treated later.Patients and methodsA total of 89 Egyptian LT recipients were treated for recurrent HCV genotype 4 after living donor LT with different DAAs±ribavirin (RBV) for 12 or 24 weeks, correspondingly, according to availability of these drugs in our country.ResultsEnd of treatment, SVR12, and SVR24 were achieved in 77.5% of patients collectively (n=69/89). Those who were treated earlier achieved higher SVR12 rates [100% in patients who were treated with a combination of sofosbuvir (SOF) and daclatasvir (n=26/26)], a combination of SOF and ledipasvir (n=2/2), and ritonavir-boosted paritaprevir and ombitasvir for 12 weeks with daily RBV (n=1/1) and 85% in patients treated with a combination of SOF and simeprevir (n=6/7) compared with their historical control of those who were treated with SOF/RBV for 24 weeks [64% SVR12 (34/53)].ConclusionEarly treatment with newer combinations of DAAs for recurrent HCV after the first 3 months after LT is recommended to achieve high rates of SVR and adequate safety profile.