Early Acute Severe HCV Recurrence After Transplantation: From Universal Mortality to Cure

Abstract

Acute severe recurrence of hepatitis C virus (HCV) after solid organ transplant is associated with high mortality. Pegylated interferon and ribavirin are suboptimal in treatment of this severe form of recurrence. We report 4 cases of acute severe HCV recurrence (within 6 months after transplant), including 3 cases with fibrosing cholestatic hepatitis treated with sofosbuvir and ribavirin. All four patients achieved a rapid suppression of HCV RNA with a normalization of liver function tests within 4 weeks of starting therapy. All patients were HCV RNA negative at 12 weeks after stopping therapy. The combination was found to be safe as anemia was the only adverse effect, which developed in 2 patients (1 patient required blood transfusion, while another managed with erythropoietin). Sofosbuvir and ribavirin appear to be safe and efficacious in treatment of acute severe HCV recurrence after organ transplant. ( J CLIN EXP HEPATOL 2017;7:28-32)

Fibrosing cholestatic hepatitis in a kidney transplant recipient with hepatitis C virus

“…Our report is the first so far on treating HCV-related FCH after kidney transplantation with Glecaprevir/Pibrentasvir. This is also the first time that HCV genotype 2a has been reported in HCVrelated FCH after kidney transplantation, in contrast to previous reports of HCV genotypes 1, 3 and 4 [6,[10][11][12][13][14][15][16][17][18].…”

“…In our case, although the viral load was decreased after DAA treatment, the patient unfortunately died. In previous reports, the duration between kidney transplantation to FCH onset was 3 (0.3-120) (median (range)) months [6,[10][11][12][13][14][15][16][17][18]. In our case, the course of FCH was considerably faster and difficult to distinguish from drug-induced liver injury, thereby delaying the start of DAA treatment.…”

“…IFN treatment increased the risk of renal graft loss or decline of renal function due to rejection [11,14], although in some cases treated with IFN rejection did not occur and sustained virological response (SVR) was achieved [15]. In contrast, treatment with direct acting antivirals (DAA) achieved SVR with good renal function [16,17]. Hematopoietic stem cell transplantation has also resulted in good renal function with SVR [18].…”

Chronic Hepatitis C: Do Generics Work as Well as Branded Drugs?

“…34 Table 3 shows the data generated from various small studies in special patient populations using generic DAAs. This has changed the course of illness in conditions as varied as fibrosing cholestatic hepatitis, 35 hematological diseases, 36,37 IV drug users, 38 postrenal transplantation 39 and chronic kidney disease on dialysis. 40,41 They have shown a high efficacy of generic drugs and offers better answers for determining choice of therapy in this difficult to treat populations.…”