Efficacy and safety of sofosbuvir‐based therapy in hepatitis C virus recurrence post living donor liver transplant: A real life egyptian experience

Abstract

Background and Aim Direct acting antiviral has offered treatment of hepatitis C virus (HCV) recurrence post liver transplantation (LT) with an all‐oral regimen for short duration, excellent safety profile, and high sustained virological response (SVR). The aim of this study was to evaluate the efficacy and safety of sofosbuvir (SOF)‐based regimens in the real world among a cohort of Egyptian patients with recurrent HCV post living donor LT (LDLT). Methods Patients with HCV‐G4 recurrence post‐LDLT were recruited from National Committee of Control of Viral Hepatitis, Egypt, from November 2014 to May 2017. They received different SOF‐based regimens according to the treatment protocols available during this period. Patients’ outcome and Adverse effects (AE) were evaluated. Results One hundred ninety patients (170 males, mean age 56.8 ± 7.9 years) were included. Calcineurin inhibitors were the main immunosuppression used (173 patients). Out of 190, 119 (62.6%) received SOF/ribavirin (RBV), 38 (20%) SOF/simeprevir (SMV), 22 (11.6%) SOF/daclatasvir (DSV)/ ± RBV, and 11 (5.8%) received SOF/LDV/ ± RBV. Overall SVR12 was 89.5%, 84.9% in SOF/RBV group, 94.7% in SOF/SMV, 100% in SOF/DCV, and 100% in SOF/LDV with no statistically significant difference ( P = 0.104). The AE reported were as follows: anemia (n = 65, 34.4%) mainly in SOF/RBV group, transient hyperbilirubinemia during SOF/SMV in 13 patients (34%), mild Acute cellular rejection in eight patients (4.2%), and hepatocellular carcinoma in two patients (1%) mainly driven by underlying liver condition. Two deaths were unlikely related to HCV therapy. Conclusion Different SOF‐based regimens were effective with high SVR12 rates in a difficult‐to‐treat population, recurrent HCV post LDLT.

Safety and Efficacy of Sofosbuvir Based Regimens in Treating Chronic ‎Hepatitis C Virus in Egyptian Patients: Real World Study: Single Center ‎Experience

“…These results are near to that obtained by Yosry et al [6], who found that, SVR12 was achieved in 94.7% in patients who received SOF/SMV for treatment of hepatitis C virus recurrence post living donor liver transplant.…”

“…Sofosbuvir has pan-genotypic effect on HCV with better pharmacokinetics and improved resistance profiles [5]. Sofosbuvir based DAAs are safe, effective, and well tolerated in patients with chronic hepatitis C patients [6].…”

Distinct Immune Imprints of Post–Liver Transplantation Hepatitis C Persist Despite Viral Clearance

“…There has been a concern that a possible restoration of some of the immune cells after HCV clearance could also bear the risk of inducing unwanted sequelae including rejection episodes in the long-run (9,10,48). There is very limited literature that addressed the repercussions of HCV elimination on immune response in post-transplantation setting.…”

“…There has been a concern that a possible restoration of some of the immune cells after HCV clearance could also bear the risk of inducing unwanted sequelae, including rejection episodes in the long run. (9,10,48) There is limited literature that addresses the repercussions of HCV elimination on immune response in the posttransplantation setting. Importantly, we showed for the first time in this study that the therapy-induced clearance of HCV after LT does not significantly normalize a larger fraction of the altered inflammatory analytes in HCV + LT patients.…”

Liver Transplantation and HCV Genotype 4

“…SVR rates were as follow: 84.9% in SOF/RBV group, 94.7% in SOF/SIM, 100% in SOF/DCV, and 100% in SOF/LDV. Treatment was well tolerated with no significant drug-drug interactions [117]. The outcome of the combination SIM + SOF ± RBV in a group of liver transplant patients with HCV genotype 4 infection in Spain was evaluated in a real life study.…”